A bill

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY AMENDING SECTION 40-43-60, RELATING TO MISCELLANEOUS REQUIREMENTS CONCERNING PHARMACIES AND THE PRACTICE OF PHARMACY, SO AS TO PROVIDE PHARMACIES PERMITTED IN THIS STATE SHALL COOPERATE WITH FEDERAL AND STATE ACQUISITION COST SURVEYS; AND BY ADDING SECTION 38-71-2270 SO AS TO PROVIDE GUIDELINES FOR PHARMACY BENEFITS MANAGERS WHEN REIMBURSING PHARMACIES AND PHARMACISTS FOR PRESCRIPTION DRUGS AND PHARMACY SERVICES.

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

SECTION 1.  Section 40-43-60 of the S.C. Code is amended by adding:

    (N) Any pharmacy with a pharmacy permit shall cooperate with federal and state acquisition cost surveys, including the National Average Drug Acquisition Cost (NADAC) survey.

SECTION 2.  Article 21, Chapter 71, Title 38 of the S.C. Code is amended by adding:

    Section 38-71-2270.  (A) A PBM may not reimburse a pharmacy or pharmacist for a prescription drug or pharmacy service in an amount less than the National Average Drug Acquisition Cost (NADAC) for the prescription drug or pharmacy service at the time the drug is administered or dispensed, plus a professional dispensing fee of no less than the current South Carolina Medicaid professional dispensing fee.

    (B) If the NADAC is not available at the time the drug is administered or dispensed, the PBM may not reimburse a pharmacy or pharmacist in an amount less than the Wholesale Acquisition Cost (WAC) of the drug as defined in 42 U.S.C. Section 1395w-3a(c)(6)(B), plus a professional dispensing fee of no less than the current South Carolina Medicaid professional dispensing fee.

    (C) A pharmacy or pharmacist that has been reimbursed below the minimum amount required by this section may file a complaint with the Department of Insurance using a standard form that the department shall post online. Upon receipt of a completed complaint form, the department shall provide the information in the form to the PBM and permit it ten business days to respond. The department shall make a determination regarding the complaint within thirty days after receiving a response from the PBM. If the complaint is upheld, the department shall notify the pharmacy or pharmacist and the PBM, which must:

       (1) pay the pharmacy or pharmacist within thirty days twice the amount of the insufficiency of the original payment; and

       (2) make the change effective for each similarly situated pharmacy and reimburse each pharmacy the amount of underpayment.

SECTION 3.  This act takes effect upon approval by the Governor.

----XX----