The bill H. 4790 aims to amend Section 38-71-2240 of the South Carolina Code of Laws, specifically addressing the operations of pharmacy benefits managers (PBMs) regarding their Maximum Allowable Cost (MAC) lists. The proposed changes require PBMs to provide unobstructed access to their MAC lists for patients, consumers, and network pharmacy providers. Additionally, the bill mandates that PBMs update their MAC lists at least once every seven calendar days and ensure that pharmacies have easy access to any updates.

Furthermore, the bill outlines several procedural requirements for PBMs, including the establishment of a reasonable internal appeal process for pharmacies to contest reimbursement rates that fall below their acquisition costs. It also calls for participation in an external review process for denied appeals and allows unaffiliated retail pharmacies to reconcile payments on the same terms as affiliated pharmacies. These amendments are designed to enhance transparency and fairness in the pricing and reimbursement processes within the pharmacy benefits management system.

Statutes affected:
12/17/2025: 38-71-2240
Latest Version: 38-71-2240