South Carolina House Bill H4795

South Carolina 2025-2026 Regular Session

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

Caption

Pharmacy Benefits Manager drug modifications

Impact

The legislation introduces significant changes to how drug coverage is managed within health benefit plans, promoting clarity and consistency in communications between benefit issuers and enrollees. By imposing requirements for advance notice of changes, H4795 seeks to protect consumers from sudden alterations that could disrupt their access to necessary medications. This regulatory approach benefits individuals who rely on specific drugs, as it enables them to plan ahead and seek alternatives if necessary, thereby enhancing patient autonomy.

Summary

House Bill H4795 aims to amend the South Carolina Code of Laws by introducing new requirements for drug coverage modifications made by Pharmacy Benefits Managers (PBMs). The legislation establishes that any changes in drug coverage by health benefit plan issuers can only occur at the time of coverage renewal. Furthermore, these modifications must apply uniformly across all groups and individuals covered by similar health benefit plans. Transparency is a critical element of H4795, as it mandates issuers to provide written notice of any changes at least sixty days before they take effect, ensuring that all impacted parties are aware of potential alterations to their drug coverage.

Contention

While supporters of H4795 argue that the bill strengthens consumer protections and promotes accountability among Pharmacy Benefits Managers, there is potential for contention regarding the operational implications for these entities. Critics may express concerns that the compliance burden associated with the notice requirements could limit the flexibility of PBMs in managing drug formularies and responding to market changes. Furthermore, stakeholders in the healthcare sector might debate the balance between maintaining consumer protections and ensuring that PBMs can effectively manage costs and access to medications.