The bill S. 342 aims to amend various sections of the South Carolina Code of Laws related to pharmacy services and pharmacy benefits managers (PBMs). It introduces a definition for "low-volume pharmacy" and establishes new regulations that restrict PBMs from reimbursing pharmacies below certain thresholds based on the National Average Drug Acquisition Cost (NADAC) and Wholesale Acquisition Cost (WAC). Additionally, the bill mandates that low-volume pharmacies receive an enhanced professional dispensing fee and allows pharmacies to file complaints with the Department of Insurance if they are reimbursed below the minimum required amounts. The bill also empowers the South Carolina Department of Health and Human Services to take direct responsibility for Medicaid pharmacy services and allows the Attorney General to take legal action against unlawful practices by PBMs.

Furthermore, the bill amends existing prohibitions on PBMs, removing certain restrictions and clarifying their obligations regarding reimbursement practices. It repeals a section related to the placement of drugs on the maximum allowable cost list and includes provisions for the Department of Insurance to regulate the implementation of these changes. The act is set to take effect on January 1, 2026, and will apply to all contracts entered into, renewed, or amended after that date.

Statutes affected:
02/13/2025: 38-71-2200, 38-71-2270, 38-71-2230, 38-71-2260, 38-71-2350, 38-71-2280, 38-71-2290, 38-71-2240
Latest Version: 38-71-2200, 38-71-2270, 38-71-2230, 38-71-2260, 38-71-2350, 38-71-2280, 38-71-2290, 38-71-2240