The bill S. 99 aims to amend the South Carolina Code of Laws by introducing new sections that define terms and establish requirements for cost sharing related to healthcare services provided by insurers and pharmacy benefit managers. Specifically, it adds Section 38-71-292 and Section 38-71-820, which outline the definitions of "cost sharing," "enrollee," "health plan," "healthcare service," and "insurer." These sections also stipulate 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, the bill mandates that insurers include any cost-sharing amounts paid by or on behalf of enrollees when calculating their contributions to cost-sharing requirements, with certain exceptions for prescription drugs with generic equivalents.

Furthermore, the bill amends Section 38-71-2200 to make conforming changes to existing definitions and introduces Section 38-71-2270, which extends similar cost-sharing requirements to pharmacy benefit managers. It emphasizes 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 entered into, amended, extended, or renewed on or after January 1, 2027, and the director may promulgate necessary regulations for implementation. The act will take effect upon approval by the Governor.

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