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 the enrollee when calculating their contribution to cost-sharing requirements.

Furthermore, the bill amends Section 38-71-2200 to make conforming changes to definitions related to pharmacy benefits managers. It emphasizes that insurers cannot condition health plan coverage terms 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. The bill also allows the director or their designee to promulgate necessary rules and regulations for implementation. Overall, S. 99 seeks to enhance transparency and fairness in cost-sharing practices for healthcare services in South Carolina.

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