South Carolina H 3934: Cost sharing

Bill Text

2025-2026 Bill 3934 Text of Previous Version (Feb. 06, 2025) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 3934

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, deductibl