The bill H. 4791 aims to amend the South Carolina Code of Laws to enhance the cooperation of pharmacies with federal and state drug acquisition cost surveys and to establish reimbursement guidelines for pharmacy benefits managers (PBMs). Specifically, it amends Section 40-43-60 to require that any pharmacy with a permit in South Carolina must cooperate with acquisition cost surveys, including the National Average Drug Acquisition Cost (NADAC) survey. Additionally, it introduces a new section, 38-71-2270, which sets forth that PBMs cannot reimburse pharmacies or pharmacists for prescription drugs or services below the NADAC, plus a professional dispensing fee that aligns with the current South Carolina Medicaid rate.

Furthermore, if the NADAC is unavailable, the bill stipulates that reimbursement must be based on the Wholesale Acquisition Cost (WAC) plus the same professional dispensing fee. It also provides a mechanism for pharmacies or pharmacists to file complaints with the Department of Insurance if they are reimbursed below the mandated minimum. The department is tasked with reviewing these complaints and, if upheld, requires the PBM to pay the pharmacy or pharmacist double the amount of the underpayment and adjust future reimbursements for similarly situated pharmacies. The bill will take effect upon the Governor's approval.

Statutes affected:
12/17/2025: 40-43-60, 38-71-2270
Latest Version: 40-43-60, 38-71-2270