H 4790

South Carolina General Assembly
126th Session, 2025-2026
Bill 4790
Indicates Matter Stricken
Indicates New Matter
(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)
A bill
TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY AMENDING
SECTION 38-71-2240, RELATING TO the PLACEMENT OF DRUGs ON MAXIMUM ALLOWABLE
COST LISTs, SO AS TO PROVIDE PHARMACY BENEFITS MANAGERS SHALL PROVIDE
UNOBSTRUCTED AcCESS TO THEIR MAXIMUM ALLOWABLE COST LISTS TO PATIENTS,
CONSUMERS, NETWORK PHARMACY PROVIDERS, AND EACH PHARMACY SUBJECT TO THE MAXIMUM
ALLOWABLE COST LIST.
Be it enacted by the
General Assembly of the State of South Carolina:
SECTION 1.  Section 38-71-2240(B) of the S.C. Code is amended to
read:
    (B) A pharmacy benefits manager
shall:
       (1)
provide a process for network pharmacy providers to
readily access the maximum allowable cost specific to that providerprovide patients, consumers, and network pharmacy providers
unobstructed access to the pharmacy benefits managers' Maximum Allowable Cost
Lists;
       (2)
update its Maximum Allowable Cost List at least once every seven calendar days;
       (3)
provide a process for each pharmacy subject to the Maximum
Allowable Cost List to access any updates to the Maximum Allowable Cost Listprovide unobstructed access to each pharmacy subject to the Maximum
Allowable Cost List to access any updates to the Maximum Allowable Cost List;
       (4)
ensure that dispensing fees are not included in the calculation of maximum
allowable cost;
       (5)
establish a reasonable internal appeal procedure by which a contracted pharmacy
can appeal the provider's reimbursement for a drug subject to maximum allowable
cost pricing if the reimbursement for the drug is less than the net amount that
the network provider paid to the suppliers of the drug.  The reasonable
internal appeal procedure must include:
  (a)
a dedicated telephone number and email address or website for the purpose of
submitting internal appeals; and
  (b)
the ability to submit an internal appeal directly to the pharmacy benefits
manager regarding the pharmacy benefits plan or program or through a pharmacy
service administrative organization if the pharmacy service administrative
organization has a contract with the pharmacy benefits manager that allows for
the submission of such appeals;
       (6)
participate in a reasonable external review procedure by which a contracted
pharmacy can request an external review of a pharmacy benefits manager's denial
of an internal appeal by an independent review organization in accordance with
the procedures promulgated by the director in subsection (F) of this section;
and
       (7)
permit an unaffiliated retail pharmacy to participate in programs that
reconcile payments with actual cost on the same basis as retail pharmacy
benefits manager affiliates.
SECTION 2.  This act takes effect upon approval
by the Governor.
----XX----
This web page was last updated on December 17, 2025 at 01:50 PM