H 4791

South Carolina General Assembly
126th Session, 2025-2026
Bill 4791
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 40-43-60, RELATING TO MISCELLANEOUS REQUIREMENTS CONCERNING PHARMACIES
AND THE PRACTICE OF PHARMACY, SO AS TO PROVIDE PHARMACIES PERMITTED IN THIS
STATE SHALL COOPERATE WITH FEDERAL AND STATE ACQUISITION COST SURVEYS; AND BY
ADDING SECTION 38-71-2270 SO AS TO PROVIDE GUIDELINES FOR PHARMACY BENEFITS
MANAGERS WHEN REIMBURSING PHARMACIES AND PHARMACISTS FOR PRESCRIPTION DRUGS AND
PHARMACY SERVICES.
Be it enacted by the
General Assembly of the State of South Carolina:
SECTION 1.  Section 40-43-60 of the S.C. Code is amended by adding:
    (N) Any pharmacy with a pharmacy permit
shall cooperate with federal and state acquisition cost surveys, including the
National Average Drug Acquisition Cost (NADAC) survey.
SECTION 2.  Article 21, Chapter 71, Title 38 of the S.C. Code is
amended by adding:
    Section
38-71-2270.  (A) A PBM may not
reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service
in an amount less than the National Average Drug Acquisition Cost (NADAC) for
the prescription drug or pharmacy service at the time the drug is administered
or dispensed, plus a professional dispensing fee of no less than the current
South Carolina Medicaid professional dispensing fee.
    (B)
If the NADAC is not available at the time the drug is administered or
dispensed, the PBM may not reimburse a pharmacy or pharmacist in an amount less
than the Wholesale Acquisition Cost (WAC) of the drug as defined in 42 U.S.C.
Section 1395w-3a(c)(6)(B), plus a professional dispensing fee of no less than
the current South Carolina Medicaid professional dispensing fee.
    (C)
A pharmacy or pharmacist that has been reimbursed below the minimum amount
required by this section may file a complaint with the Department of Insurance
using a standard form that the department shall post online. Upon receipt of a
completed complaint form, the department shall provide the information in the
form to the PBM and permit it ten business days to respond. The department
shall make a determination regarding the complaint within thirty days after
receiving a response from the PBM. If the complaint is upheld, the department
shall notify the pharmacy or pharmacist and the PBM, which must:
       (1)
pay the pharmacy or pharmacist within thirty days twice the amount of the
insufficiency of the original payment; and
       (2)
make the change effective for each similarly situated pharmacy and reimburse
each pharmacy the amount of underpayment.
SECTION 3.  This act takes effect upon approval
by the Governor.
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This web page was last updated on December 17, 2025 at 01:50 PM