The bill S. 99 aims to amend the South Carolina Code of Laws by introducing new sections that define terms and outline the applicability and requirements for cost sharing related to healthcare services provided by insurers and pharmacy benefit managers. Specifically, it adds Sections 38-71-292 and 38-71-820, which establish definitions for key terms such as "cost sharing," "enrollee," "health plan," and "healthcare service." The bill mandates that the annual limitation on cost sharing, as provided under federal law, applies to all healthcare services covered by health plans in South Carolina. Additionally, it requires insurers and pharmacy benefit managers to include any cost-sharing amounts paid by or on behalf of enrollees when calculating their contributions to applicable cost-sharing requirements.

Furthermore, the bill amends Section 38-71-2200 to make conforming changes to existing definitions and introduces Section 38-71-2270, which extends the cost-sharing requirements to health benefit plans administered by pharmacy benefit managers. It also stipulates that insurers cannot condition health plan coverage based on the availability of financial assistance for prescription drugs. The provisions of this bill will apply to health plans that are entered into, amended, extended, or renewed on or after January 1, 2027, and the director or their designee is authorized to promulgate necessary rules and regulations for implementation.

Statutes affected:
12/11/2024: 38-71-292, 38-71-820, 38-71-2270, 38-71-2200
Latest Version: 38-71-292, 38-71-820, 38-71-2270, 38-71-2200