A bill

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY AMENDING SECTION 38-71-2240, RELATING TO the PLACEMENT OF DRUGs ON MAXIMUM ALLOWABLE COST LISTs, SO AS TO PROVIDE PHARMACY BENEFITS MANAGERS SHALL PROVIDE UNOBSTRUCTED AcCESS TO THEIR MAXIMUM ALLOWABLE COST LISTS TO PATIENTS, CONSUMERS, NETWORK PHARMACY PROVIDERS, AND EACH PHARMACY SUBJECT TO THE MAXIMUM ALLOWABLE COST LIST.

Be it enacted by the General Assembly of the State of South Carolina:

SECTION 1.  Section 38-71-2240(B) of the S.C. Code is amended to read:

    (B) A pharmacy benefits manager shall:

       (1) provide a process for network pharmacy providers to readily access the maximum allowable cost specific to that providerprovide patients, consumers, and network pharmacy providers unobstructed access to the pharmacy benefits managers' Maximum Allowable Cost Lists;

       (2) update its Maximum Allowable Cost List at least once every seven calendar days;

       (3) provide a process for each pharmacy subject to the Maximum Allowable Cost List to access any updates to the Maximum Allowable Cost Listprovide unobstructed access to each pharmacy subject to the Maximum Allowable Cost List to access any updates to the Maximum Allowable Cost List;

       (4) ensure that dispensing fees are not included in the calculation of maximum allowable cost;

       (5) establish a reasonable internal appeal procedure by which a contracted pharmacy can appeal the provider's reimbursement for a drug subject to maximum allowable cost pricing if the reimbursement for the drug is less than the net amount that the network provider paid to the suppliers of the drug.  The reasonable internal appeal procedure must include:

           (a) a dedicated telephone number and email address or website for the purpose of submitting internal appeals; and

           (b) the ability to submit an internal appeal directly to the pharmacy benefits manager regarding the pharmacy benefits plan or program or through a pharmacy service administrative organization if the pharmacy service administrative organization has a contract with the pharmacy benefits manager that allows for the submission of such appeals;

       (6) participate in a reasonable external review procedure by which a contracted pharmacy can request an external review of a pharmacy benefits manager's denial of an internal appeal by an independent review organization in accordance with the procedures promulgated by the director in subsection (F) of this section; and

       (7) permit an unaffiliated retail pharmacy to participate in programs that reconcile payments with actual cost on the same basis as retail pharmacy benefits manager affiliates.

SECTION 2.  This act takes effect upon approval by the Governor.

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