The "Patients' Right to Transparency and Timely Access to Healthcare Services Act" is designed to improve the transparency and efficiency of healthcare services in South Carolina. Key provisions include the establishment of a fair prior authorization process for medications and treatments, with specific timelines for preauthorization decisions. The bill exempts healthcare providers from prior authorization if they achieve a 90% approval rate for their requests and prohibits ongoing prior authorization for patients with chronic conditions once granted. It also restricts insurance companies from changing pharmaceuticals during a policy year and mandates that health carriers publicly disclose their prior authorization requirements.

Additionally, the bill requires health carriers to assist patients in obtaining necessary information for prior authorization and to make timely decisions regarding these requests for both urgent and nonurgent medical care. It prohibits prior authorization for emergency medical care and ensures that authorizations for chronic conditions remain valid unless treatment changes. The legislation also establishes protocols for step therapy, requiring that clinical review criteria be based on high-quality studies and developed by unbiased expert panels. The act will take effect upon the Governor's approval and will apply to health insurance plans renewed on or after January 1, 2026.

Statutes affected:
04/02/2025: 44-116-10, 44-116-20, 44-116-30, 44-116-40, 44-116-50, 44-116-60, 44-116-70, 44-116-80, 44-116-90, 44-116-100, 44-116-110
Latest Version: 44-116-10, 44-116-20, 44-116-30, 44-116-40, 44-116-50, 44-116-60, 44-116-70, 44-116-80, 44-116-90, 44-116-100, 44-116-110