South Carolina Senate Bill S0342

South Carolina 2025-2026 Regular Session

• Introduced: 2/13/25
• Refer: 2/13/25

Caption

Pharmacy services

Impact

The bill introduces stricter requirements on how PBMs reimburse pharmacies, mandating that reimbursement must exceed certain thresholds related to the National Average Drug Acquisition Cost (NADAC) and professional dispensing fees. This change is designed to enhance the financial sustainability of pharmacies and facilitate fairer compensation for their services, particularly benefitting smaller or low-volume pharmacies that may struggle under existing reimbursement practices.

Summary

Bill S0342 aims to amend several sections of the South Carolina Code of Laws with specific focus on the practices of pharmacy benefits managers (PBMs) and the regulation of pharmacy services. A significant part of the bill is the definition of 'low-volume pharmacy', categorizing pharmacies that dispense fewer than 65,000 prescriptions annually. This classification is essential for determining reimbursement rates and ensuring that smaller pharmacies can sustain their operations amid competitive pressures from larger entities.

Contention

While supporters argue that the bill will provide necessary protections for pharmacies and improve patient access to medications, opponents have raised concerns about the broader implications for healthcare costs and PBM operations. There is apprehension that enhanced regulation could lead to increased prices for consumers, particularly if PBMs find ways to pass on costs incurred from compliance. Additionally, provisions allowing the South Carolina Department of Health and Human Services to take over Medicaid pharmacy services from managed care organizations may introduce some disruptions in existing contractual relationships, leading to unease among stakeholders in the healthcare community.