South Carolina H 4791: Drug acquisition cost surveys and reimbursement guidelines

Bill Text

2025-2026 Bill 4791 Text of Previous Version (Dec. 17, 2025) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 4791

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 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.

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This web page was last updated on December 17, 2025 at 01:50 PM