The bill H. 4794 aims to amend the South Carolina Code of Laws regarding Pharmacy Benefits Managers (PBMs) by updating definitions and prohibiting certain trade practices. It introduces a new definition for "spread pricing," which refers to a pricing model where the PBM charges a health benefit plan a different price for prescription drugs than what it pays the pharmacy. Additionally, the bill revises the definition of "specialized delivery drug" to include specific criteria related to handling, monitoring, and treatment of chronic or rare medical conditions.

Furthermore, the bill outlines a series of prohibited actions for PBMs, including engaging in unfair trade practices, conducting spread pricing, and steering patients to pharmacies in which they have an ownership interest without proper disclosure. It also prohibits practices such as retroactively denying claims, reimbursing local pharmacies less than chain pharmacies, and failing to honor maximum allowable cost prices. The bill emphasizes transparency in pricing and requires that any rebates received be reflected in the cost-sharing calculations for enrollees. Overall, the legislation seeks to enhance consumer protection and ensure fair practices within the pharmacy benefits management sector.

Statutes affected:
12/17/2025: 38-71-2200, 38-71-2230
Latest Version: 38-71-2200, 38-71-2230