The "Patients' Right to Transparency and Timely Access to Healthcare Services Act" is designed to improve the prior authorization process for healthcare services in South Carolina. Key provisions include the establishment of a fair and transparent prior authorization process, specific timelines for decision-making, and exemptions for healthcare providers who achieve a 90% approval rate for their requests. The bill also prohibits ongoing prior authorization for patients with chronic conditions once initial authorization is granted and restricts insurance companies from changing pharmaceuticals during a policy year. Additionally, it mandates that health carriers publicly disclose their prior authorization requirements and ensures that adverse determinations are made by qualified physicians.

The legislation further 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 bill also outlines conditions for modifying lists of covered prescription drugs and establishes guidelines for step therapy protocols, ensuring transparency and access to exception processes for patients and healthcare professionals. The Department of Insurance will enforce these provisions, and the bill is set to take effect upon the Governor's approval for health insurance plans issued or 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