South Carolina House Bill H4790

South Carolina 2025-2026 Regular Session

• Introduced: 1/13/26
• Refer: 1/13/26

Caption

Pharmacy Benefits Managers - Maximum Allowable Cost Lists

Impact

The enactment of H4790 will significantly influence the way PBMs operate within South Carolina, particularly by promoting a more transparent environment regarding drug pricing. Patients and pharmacies will benefit from clearer communication regarding their costs, which could reduce instances of confusion or disputes between pharmacies and PBMs. This increase in accessibility is expected to lead to a more competitive pricing landscape in the pharmacy sector.

Summary

House Bill H4790 aims to amend Section 38-71-2240 of the South Carolina Code of Laws by requiring that pharmacy benefits managers (PBMs) provide unobstructed access to their maximum allowable cost lists. This is intended to enhance transparency in drug pricing and ensure that patients, consumers, and network pharmacy providers have readily available information regarding drug costs. The bill mandates that basis for maximum allowable costs be updated at least once every seven days, providing a mechanism for pharmacies and patients to understand pricing dynamics better.

Contention

While many advocate for H4790 as a necessary step towards greater transparency in healthcare, there may be contention surrounding its practical implementation. Critics could argue that the mandates placed on PBMs may lead to operational adjustments that are difficult to execute swiftly, potentially disrupting services. Furthermore, there could be concerns from PBMs about how these changes affect their business models and profitability, leading to debates about patient care versus business interests within the pharmacy sector.