South Carolina S 330: Cost sharing

Bill Text

2025-2026 Bill 330 Text of Previous Version (Feb. 11, 2025) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 330

Indicates Matter Stricken
Indicates New Matter

(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)

A bill

TO AMEND THE SOUTH CAROLINA CODE OF LAWS 
BY ADDING SECTION 38-71-295 SO AS TO DEFINE TERMS AND TO INCLUDE REFERENCES TO 
THE FEDERAL INTERNAL REVENUE CODE FOR PURPOSES OF COST SHARING; AND BY ADDING 
SECTION 38-71-2270 SO AS TO DEFINE TERMS AND TO INCLUDE REFERENCES TO THE 
FEDERAL INTERNAL REVENUE CODE FOR PURPOSES OF COST SHARING.

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

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

 Section 
38-71-295. (A) as used in this 
section:

 (1) "Cost sharing" means any 
copayment, coinsurance, deductible, or other similar charges required of an 
enrollee for a healthcare service covered by a health plan, including a 
prescription drug, and paid by or on behalf of such enrollee.

 (2) "Enrollee" means any individual 
entitled to healthcare services from an insurer.

 (3) "Healthcare service" means an item 
or service furnished to any individual for the purpose of preventing, 
alleviating, curing, or healing human illness, injury, or physical disability.

 (4) "Health plan" means a policy, 
contract, certification, or agreement offered or issued by an insurer to 
provide, deliver, arrange for, pay for, or reimburse any of the costs of 
healthcare services.

 (5) "Insurer" means an entity subject 
to the insurance laws and rules of insurance in this State or subject to the 
jurisdiction of the director, that contracts or offers to contract to provide, 
deliver, arrange for, pay for, or reimburse any of the costs of healthcare 
services under a health plan in this State.

 (6) "Person" means a natural person, 
corporation, mutual company, unincorporated association, partnership, joint 
venture, limited liability company, trust, estate, foundation, not-for-profit 
corporation, unincorporated organization, government or governmental 
subdivision or agency. 

 (7) "Third-party administrator" means 
any person that directly or indirectly solicits or effects coverage of, 
underwrites, collects charges or premiums from, arranges alternative access to 
or funding for prescription drugs, or adjusts or settles claims on, residents 
of this State or residents of another state from offices in this State, in 
connection with health insurance coverage.

 (B) The annual limitation on cost 
sharing provided for under 42 U.S.C. Section 18022(c)(1) applies to all 
healthcare services covered under any health plan offered or issued by an 
insurer in this State.

 (C) When calculating an enrollee's 
contribution to any applicable cost-sharing requirement, an insurer or 
third-party administrator must include any cost-sharing amounts paid by the 
enrollee or on behalf of the enrollee by another person. If under federal law, 
application of this requirement would result in Health Savings Account 
ineligibility under Section 223 of the federal Internal Revenue Code, this 
requirement applies for Health Savings Account-qualified High Deductible Health 
Plans with respect to the deductible of such a plan after the enrollee has 
satisfied the minimum deductible under Section 223, except for with respect to 
items or services that are preventive care pursuant to Section 223(c)(2)(C) of 
the federal Internal Revenue Code, in which case the requirements of this 
paragraph applies regardless of whether the minimum deductible under Section 
223 has been satisfied.

 (D) Subsection (C) does not apply to a 
prescription drug for which there is a medically appropriate generic 
equivalent, unless the enrollee has obtained access to the brand name 
prescription drug through prior authorization, a step therapy protocol, the 
insurer's exceptions and appeals process, or as specified in Section 39-24-30 
(A).

 (E) An insurer or third-party 
administrator may not directly or indirectly set, alter, implement, or 
condition the terms of health plan coverage, including the benefit design, 
based in part or entirely on information about the availability or amount of financial 
or product assistance available for a prescription drug. 

 (F) This section applies with respect 
to health plans that are entered into, amended, extended, or renewed on or 
after January 1, 2026. 

 (G) In implementing the requirements 
of this section, the State only may regulate an insurer to the extent 
permissible under applicable law. 

 (H) The director or his designee may 
promulgate rules and regulations as it deems necessary to implement this 
section.

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

 Section 38-71-2270. (A) As used in this section:

 (1) "Cost sharing" means any 
copayment, coinsurance, deductible, or