South Carolina House Bill H4794

South Carolina 2025-2026 Regular Session

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

Caption

Pharmacy Benefits Managers - Trade Practices

Impact

The amendments proposed by H4794 would significantly impact the practices of pharmacy benefits managers within South Carolina. Notably, it restricts practices such as patient steering—where PBMs might direct patients towards pharmacies in which they hold ownership interests—without proper disclosure. Additionally, the bill aims to eliminate unfair trade practices, ensuring that local pharmacies are not reimbursed less than larger chain or mail-order pharmacies for the same services or products. These changes are expected to foster a competitive market and protect local pharmacies.

Summary

House Bill 4794 seeks to amend the South Carolina Code, specifically Sections 38-71-2200 and 38-71-2230, to better regulate the actions of pharmacy benefits managers (PBMs). The bill introduces several definitions relevant to pharmacy practices, including the concept of 'spread pricing', a model in which the PBM charges a health benefit plan more than what it reimburses a pharmacy. By prohibiting certain actions, the bill aims to create a more transparent and fair operating environment for pharmacies and beneficiaries alike.

Contention

There are points of contention surrounding this bill, particularly regarding the limitations imposed on the pharmacy benefits managers. Critics might argue that regulating PBMs too tightly could lead to unintended consequences, such as increasing drug prices or limiting access to certain medications for patients. Furthermore, concerns about how these regulations could affect the broader healthcare market and the balance between maintaining profitability for PBMs and ensuring fairness in pharmacy practices remain topics of active debate.