Pharmacy Benefits Manager drug modifications

2025-2026 Bill 4795: Pharmacy Benefits Manager drug modifications - South Carolina Legislature Online

South Carolina General Assembly
126th Session, 2025-2026
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H. 4795
STATUS INFORMATION
General Bill
Sponsors: Reps. Sessions, Schuessler, Davis, B.L. Cox, Lawson, C. Mitchell, Pope, Kilmartin, White, Guest, Taylor and Crawford
Document Path: LC-0492WAB26.docx
Introduced in the House on January 13, 2026
Currently residing in the House
Summary: Pharmacy Benefits Manager drug modifications
HISTORY OF LEGISLATIVE ACTIONS

Date

Body

Action Description with journal page number

12/16/2025

House

Prefiled

12/16/2025

House

Referred to Committee on
Labor, Commerce and Industry

1/13/2026

House

Introduced and read first time (
House Journal-page 93
)

1/13/2026

House

Referred to Committee on
Labor, Commerce and Industry
(
House Journal-page 93
)

1/14/2026

House

Member(s) request name added as sponsor: Kilmartin

1/20/2026

House

Member(s) request name added as sponsor: White

1/21/2026

House

Member(s) request name added as sponsor: Guest

2/3/2026

House

Member(s) request name added as sponsor: Taylor

4/29/2026

House

Member(s) request name added as sponsor: Crawford

View the latest
legislative information
at the website
VERSIONS OF THIS BILL
12/17/2025

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.

B
e it enacted by the
General Assembly of the State of South Carolina:

S
ECTION 1.
A
rticle 21, Chapter 71, Title 38 of the S.C. Code is
amended by adding:

S
ection
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.

S
ECTION 2. This act takes effect upon approval
by the Governor.

----XX----

This web page was last updated on January 13, 2026 at 2:41 PM