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). Key provisions include the definition of "low-volume pharmacy," which is defined as a pharmacy dispensing fewer than sixty-five thousand prescriptions annually. The bill introduces restrictions on PBMs regarding reimbursement rates, ensuring they do not pay less than 104% of the National Average Drug Acquisition Cost (NADAC) or the Wholesale Acquisition Cost (WAC) plus a professional dispensing fee. It also mandates that low-volume pharmacies receive an enhanced dispensing fee and allows pharmacies to file complaints with the Department of Insurance if they are reimbursed below the minimum required amounts.

Additionally, the bill removes certain prohibitions on PBM activities, such as the prohibition on claims reconciliation and antisteering provisions, while empowering the Attorney General to take legal action against unlawful practices by PBMs. The South Carolina Department of Health and Human Services is granted the authority to assume direct responsibility for Medicaid pharmacy services, with provisions for implementing best practices to control costs. The bill also repeals a section related to the placement of drugs on the maximum allowable cost list. 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