The bill H. 4795 aims to amend the South Carolina Code of Laws by adding Section 38-71-2247, which establishes specific requirements for drug coverage modifications made by Pharmacy Benefits Managers (PBMs). Under this new section, health benefit plan issuers are permitted to modify drug coverage during the time of coverage renewal, provided that the modifications are applied uniformly across all affected plans and that written notice is given to relevant parties at least sixty days prior to the modification's effective date. The bill outlines various types of modifications that would require such notice, including the removal of drugs from formularies, prior authorization requirements, quantity limits, step-therapy restrictions, and changes to cost-sharing tiers.

Additionally, the bill allows health benefit plan issuers to offer enrollees the option to receive notifications via email and permits patients to waive the protections provided under the new section, as long as such waivers are made voluntarily and without coercion. Any waiver that does not comply with these conditions would be considered void. The act is set to take effect upon approval by the Governor.

Statutes affected:
12/17/2025: 38-71-2247
Latest Version: 38-71-2247