Bill > S0100

This bill amends South Carolina insurance law to establish new regulations around cost-sharing for health insurance and pharmacy benefits. The bill defines key terms like "cost sharing" (copayments, coinsurance, deductibles), "enrollee" (individuals entitled to healthcare services), and "health plan" (insurance policies providing healthcare coverage). It mandates that insurers and pharmacy benefit managers (PBMs) apply the annual federal cost-sharing limitation to all healthcare services and prescription drugs. When calculating an enrollee's cost-sharing contributions, insurers must include amounts paid by the enrollee or on their behalf by other parties, with specific provisions to maintain Health Savings Account eligibility. The bill prohibits insurers from altering health plan terms based on the availability of financial assistance for prescription drugs. These regulations will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2027. The bill also updates definitions related to pharmacy benefits management and adds new sections to the state insurance code to implement these requirements, with the director of insurance authorized to create implementing rules and regulations.

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https://www.scstatehouse.gov/billsearch.php?billnumbers=100&session=126&summary=B