Bill > S0330

This bill amends South Carolina insurance law by adding two new sections that establish comprehensive regulations around cost sharing in health plans, with a focus on prescription drugs and pharmacy benefit management. The bill defines key terms like "cost sharing" (copayments, coinsurance, deductibles), "enrollee", "healthcare service", and "health plan", and applies the annual cost-sharing limitation from federal law (42 U.S.C. Section 18022(c)(1)) to all health plans in the state. It requires insurers and pharmacy benefit managers to include all cost-sharing amounts paid by or on behalf of an enrollee when calculating cost-sharing contributions, with specific provisions to maintain Health Savings Account eligibility. The bill also prohibits insurers and pharmacy benefit managers from setting health plan terms based on the availability of financial assistance for prescription drugs. Notably, these regulations will apply to health plans entered into, amended, extended, or renewed on or after January 1, 2026, and the state insurance director is authorized to create rules and regulations to implement these provisions. The bill aims to provide more transparency and consumer protection in healthcare cost sharing, particularly for prescription medications.

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https://www.scstatehouse.gov/billsearch.php?billnumbers=0330&session=126&summary=B