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 insurers and pharmacy benefit managers. The bill defines "cost sharing," "enrollee," "healthcare service," "health plan," "insurer," and "pharmacy benefit manager," among other terms. It 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, it mandates that when calculating an enrollee's cost-sharing contributions, all amounts paid by the enrollee or on their behalf must be included, with specific provisions for Health Savings Accounts and preventive care.

Furthermore, the bill prohibits insurers and pharmacy benefit managers from altering health plan coverage terms based on the availability of financial assistance for prescription drugs. It also clarifies that these regulations will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2026. The bill allows the director or their designee to promulgate necessary rules and regulations for implementation, ensuring that the state can regulate insurers and pharmacy benefit managers within the limits of applicable law.

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