A bill

 

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY ADDING SECTION 38-71-2247 SO AS TO PROVIDE REQUIREMENTS FOR DRUG COVERAGE MODIFICATIONS BY PHARMACY BENEFITS MANAGERS.

 

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

 

SECTION 1.  Article 21, Chapter 71, Title 38 of the S.C. Code is amended by adding:

 

    Section 38-71-2247.  (A) A health benefit plan issuer may modify drug coverage provided under a health benefit plan if:

       (1) the modification occurs at the time of coverage renewal;

       (2) the modification is effective uniformly among all group health benefit plan sponsors covered by identical or substantially identical health benefit plans or all individuals covered by identical or substantially identical individual health benefit plans, as applicable; and

       (3) no later than the sixtieth day before the date the modification is effective, the issuer provides written notice of the modification to the commissioner, each affected group health benefit plan sponsor, each affected enrollee in an affected group health benefit plan, and each affected individual health benefit plan holder.

    (B) A modification affecting drug coverage that requires notice under subsection (A) includes:

       (1) removing a drug from a formulary;

       (2) adding a requirement that an enrollee receive prior authorization for a drug;

       (3) imposing or altering a quantity limit for a drug;

       (4) imposing a step-therapy restriction for a drug; and

       (5) moving a drug to a higher cost-sharing tier unless a generic drug alternative to the drug is available.

    (C) A health benefit plan issuer may elect to offer an enrollee in the plan the option of receiving notifications required by this section by email.

    (D) A patient may knowingly and voluntarily waive protections afforded them under (A), but cannot be induced or coerced by any means to do so. Any waiver made in violation of this subsection is void.

 

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

----XX----