South Carolina 2025-2026 Regular Session

South Carolina House Bill H4791

Introduced
1/13/26  

Caption

Drug acquisition cost surveys and reimbursement guidelines

Impact

The bill's implications on state laws would establish specific guidelines and protections for pharmacies regarding reimbursement amounts for services rendered. By requiring that reimbursements meet or exceed NADAC and the current South Carolina Medicaid dispensing fee, the bill aims to enhance the financial viability of pharmacies. The potential for pharmacies to file complaints with the Department of Insurance further supports their rights and seeks to ensure accountability from PBMs in their financial practices.

Summary

House Bill 4791 seeks to amend various sections of the South Carolina Code of Laws, specifically focusing on the requirements concerning pharmacies and their cooperation with federal and state acquisition cost surveys. The bill mandates that pharmacies with proper permits must align with the National Average Drug Acquisition Cost (NADAC) and outlines the expected reimbursement practices from pharmacy benefits managers (PBMs). This legislative effort is part of a broader initiative to ensure fair practices in the pharmacy industry, especially concerning the pricing of prescription drugs and pharmacy services.

Contention

One notable point of contention surrounding HB 4791 may involve the operational realities and economic impacts on pharmacy benefits managers as they adjust to the new reimbursement requirements. While proponents argue that the bill offers needed protections for pharmacies ensuring they do not receive below-cost reimbursements, opponents may raise concerns about the administrative burden this creates on PBMs and potential ripple effects throughout the healthcare system. The balance between equitable reimbursement for pharmacies and the operational flexibility of PBMs could provoke discussion among stakeholders in the pharmacy and insurance sectors.

Companion Bills

No companion bills found.

Previously Filed As

SC H5254

Requires pharmacy benefit managers to reimburse pharmacist no less than national drug acquisition costs plus fee.

SC S0222

Requires pharmacy benefit managers to reimburse pharmacist no less than national drug acquisition costs plus fee.

SC HB1236

Provides relative to pharmacy benefit managers reimbursements (RE1 +$2,265,844 SG EX See Note)

SC HB4533

Relating to the reimbursement of prescription drugs under Medicaid and the child health plan program.

SC HB866

Prohibits pharmacy benefit managers and managed care plans from reducing pharmacy reimbursements (OR +$11,093,778 SG EX See Note)

SC SB247

Prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.

SC SB247

Prohibiting network exclusion for pharmacies that refuse to dispense a prescription of the PBM reimbursement that is below the pharmacy's acquisition cost.

SC A05882

Requires a pharmacy benefit manager to pay a participating pharmacy at minimum at the national average drug acquisition cost (NADAC) rate, or at the pharmacy acquisition cost rate if greater or there is not a NADAC rate, plus a professional dispensing fee that is at minimum the professional dispensing fee paid under the state medical assistance program.

SC SB789

Pharmacy benefit managers; permitting use of certain records without limitations of date or source for certain purposes; establishing certain reimbursement rates for certain drugs. Effective date.

SC SB789

Pharmacy benefit managers; permitting use of certain records without limitations of date or source for certain purposes; establishing certain reimbursement rates for certain drugs. Effective date.

Similar Bills

KY HB614

AN ACT relating to professional dispensing fees for prescription drugs and declaring an emergency.

AZ HB4124

Health insurance; pharmacy; reimbursement rates

LA HB866

Prohibits pharmacy benefit managers and managed care plans from reducing pharmacy reimbursements (OR +$11,093,778 SG EX See Note)

MS HB1119

Pharmacy benefit managers; revise provisions related to.

LA HB1236

Provides relative to pharmacy benefit managers reimbursements (RE1 +$2,265,844 SG EX See Note)

MS SB2677

Pharmacy Benefit Prompt Pay Act; define requirements for pharmacy benefit managers and pharmacy services administrative organizations.

MA H4488

Relative to pharmacy benefit managers reimbursements to pharmacies in the Commonwealth

MO HB1975

Modifies provisions relating to pharmacy benefits managers