The bill H. 3575 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 and prescription drugs. Specifically, it adds Section 38-71-292 and Section 38-71-820, which outline the applicability of cost-sharing for insurers and pharmacy benefit managers, respectively. Both sections define key terms such as "cost sharing," "enrollee," "health plan," and "healthcare service," and stipulate that the annual limitation on cost sharing under federal law applies to all healthcare services covered by health plans in South Carolina. Additionally, the bill mandates that insurers and pharmacy benefit managers include any cost-sharing amounts paid by or on behalf of enrollees when calculating their contributions to cost-sharing requirements.

Furthermore, the bill amends Section 38-71-2200 to make conforming changes to existing definitions related to pharmacy benefits managers. It specifies that insurers cannot condition health plan coverage based on the availability of financial assistance for prescription drugs and sets forth that these provisions will apply to health plans entered into or renewed after January 1, 2027. The bill also allows the director or their designee to promulgate necessary rules and regulations for implementation. Overall, H. 3575 seeks to enhance transparency and fairness in cost-sharing practices for healthcare services and prescription drugs in South Carolina.

Statutes affected:
12/12/2024: 38-71-292, 38-71-820, 38-71-2270, 38-71-2200
01/07/2025: 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
01/07/2025-A: 38-71-292, 38-71-820, 38-71-2270, 38-71-2200
01/07/2025-B: 38-71-292, 38-71-820, 38-71-2270, 38-71-2200