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." It mandates that the annual limitation on cost sharing, as specified in federal law, applies to all healthcare services covered under health plans in South Carolina. Additionally, it requires insurers to 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. The bill prohibits insurers from altering health plan coverage terms based on the availability of financial assistance for prescription drugs and specifies that these provisions apply to health plans entered into or renewed after January 1, 2027. The director of the insurance department is also granted the authority 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