South Carolina H 4790: Pharmacy Benefits Managers - Maximum Allowable Cost Lists

Bill Text

2025-2026 Bill 4790 Text of Previous Version (Dec. 17, 2025) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 4790

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 38-71-2240, RELATING TO the PLACEMENT OF DRUGs ON MAXIMUM ALLOWABLE 
COST LISTs, SO AS TO PROVIDE PHARMACY BENEFITS MANAGERS SHALL PROVIDE 
UNOBSTRUCTED AcCESS TO THEIR MAXIMUM ALLOWABLE COST LISTS TO PATIENTS, 
CONSUMERS, NETWORK PHARMACY PROVIDERS, AND EACH PHARMACY SUBJECT TO THE MAXIMUM 
ALLOWABLE COST LIST.

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

SECTION 1. Section 38-71-2240(B) of the S.C. Code is amended to 
read:

 (B) A pharmacy benefits manager 
shall:

 (1) 
provide a process for network pharmacy providers to 
readily access the maximum allowable cost specific to that providerprovide patients, consumers, and network pharmacy providers 
unobstructed access to the pharmacy benefits managers' Maximum Allowable Cost 
Lists;

 (2) 
update its Maximum Allowable Cost List at least once every seven calendar days;

 (3) 
provide a process for each pharmacy subject to the Maximum 
Allowable Cost List to access any updates to the Maximum Allowable Cost Listprovide unobstructed access to each pharmacy subject to the Maximum 
Allowable Cost List to access any updates to the Maximum Allowable Cost List;

 (4) 
ensure that dispensing fees are not included in the calculation of maximum 
allowable cost;

 (5) 
establish a reasonable internal appeal procedure by which a contracted pharmacy 
can appeal the provider's reimbursement for a drug subject to maximum allowable 
cost pricing if the reimbursement for the drug is less than the net amount that 
the network provider paid to the suppliers of the drug. The reasonable 
internal appeal procedure must include:

 (a) 
a dedicated telephone number and email address or website for the purpose of 
submitting internal appeals; and

 (b) 
the ability to submit an internal appeal directly to the pharmacy benefits 
manager regarding the pharmacy benefits plan or program or through a pharmacy 
service administrative organization if the pharmacy service administrative 
organization has a contract with the pharmacy benefits manager that allows for 
the submission of such appeals;

 (6) 
participate in a reasonable external review procedure by which a contracted 
pharmacy can request an external review of a pharmacy benefits manager's denial 
of an internal appeal by an independent review organization in accordance with 
the procedures promulgated by the director in subsection (F) of this section; 
and

 (7) 
permit an unaffiliated retail pharmacy to participate in programs that 
reconcile payments with actual cost on the same basis as retail pharmacy 
benefits manager affiliates.

SECTION 2. 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