Bill > H4790

This bill amends South Carolina law to enhance transparency and fairness in how Pharmacy Benefits Managers (PBMs) - organizations that manage prescription drug benefits for health insurers and employers - handle Maximum Allowable Cost (MAC) lists. The bill requires PBMs to provide unobstructed access to their MAC lists for patients, consumers, and network pharmacy providers, and to update these lists at least every seven calendar days. Additionally, the bill mandates that PBMs establish a reasonable internal appeal process for pharmacies to challenge reimbursement rates that are lower than what they paid for a drug, including providing a dedicated contact method for appeals. The bill also requires PBMs to participate in an external review procedure where an independent review organization can assess denied internal appeals, and to allow unaffiliated retail pharmacies to participate in payment reconciliation programs on the same terms as their own affiliated pharmacies. Importantly, the bill specifies that dispensing fees cannot be included in calculating maximum allowable costs. The legislation will take effect upon approval by the Governor, with the goal of increasing transparency and fairness in prescription drug pricing and reimbursement.

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https://www.scstatehouse.gov/billsearch.php?billnumbers=4790&session=126&summary=B