The bill H. 3934 aims to amend the South Carolina Code of Laws by adding two new sections, 38-71-295 and 38-71-2270, which define terms related to cost sharing in healthcare and establish regulations for health plans and pharmacy benefit managers. The bill defines "cost sharing," "enrollee," "healthcare service," "health plan," "insurer," and "person," among other terms, to clarify the responsibilities and definitions applicable to healthcare services. It also stipulates 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 when calculating an enrollee's cost-sharing contributions, insurers and pharmacy benefit managers must include amounts paid by the enrollee or on their behalf. It specifies that this requirement does not apply to certain prescription drugs with generic equivalents unless specific conditions are met. Furthermore, it prohibits insurers and pharmacy benefit managers from altering health plan coverage terms based on financial assistance information for prescription drugs. The provisions of this bill will take effect for health plans entered into or renewed on or after January 1, 2026.

Statutes affected:
02/06/2025: 38-71-295, 38-71-2270
Latest Version: 38-71-295, 38-71-2270