The "Patients' Right to Transparency and Timely Access to Healthcare Services Act" aims to improve transparency and accessibility in healthcare services in South Carolina by establishing a fair prior authorization process for medications and treatments. Key provisions include setting timelines for preauthorization decisions, exempting healthcare providers who achieve a 90% approval rate from prior authorization requirements, and prohibiting ongoing prior authorization for patients with chronic conditions once granted. The bill also restricts insurance companies from changing pharmaceuticals during a policy year and mandates that health carriers publicly disclose prior authorization requirements while ensuring that adverse determinations are made by qualified physicians.

Additionally, the bill requires healthcare providers to assist patients in obtaining necessary information for prior authorization and mandates timely decisions from health carriers 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 step therapy protocols based on high-quality studies and requires health carriers to provide clear processes for requesting exceptions. The Department of Insurance will oversee the enforcement of these provisions, with the act taking effect upon the Governor's approval and applicable to health 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