SOUTH CAROLINA SUMMARY OF EXISTING LAW

PBMs are prohibited from charging or collecting a copayment from an insured that exceeds the total submitted charges by the network pharmacy; or charging or holding a pharmacist or pharmacy responsible for a fee relating to the adjudication of a claim unless the fee is reported on the remittance advice of the adjudicated claim or is set out in contract between the pharmacy benefits manager and the pharmacy.

Link to Existing Law: SC ST § 38-71-2150

PRACTICAL NOTE

Limits what PBMs can charge via their own contracts. Allows more transparency by requiring that the PBMs set the fee via the contract or report the fee on remittance. Helps combat the element of surprise that happens often with DIR fees. However, it must be noted that these requirements are limited to insurance plans regulated by the State, and would exclude Medicare Part D, TRICARE, and possibly ERISA-regulated plans.