Section effective until January 1, 2021.

(A) As used in this article:

Terms Used In South Carolina Code 38-71-2110

  • Contract: A legal written agreement that becomes binding when signed.
  • Department: means the Department of Insurance of South Carolina. See South Carolina Code 38-1-20
  • insurance: includes annuities. See South Carolina Code 38-1-20
  • Insurer: means an entity that provides health insurance coverage in this State as defined in Section 38-71-670(7) and Section 38-71-840(16). See South Carolina Code 38-71-2110
  • List: means the list of drugs for which a pharmacy benefit manager has established a maximum allowable cost. See South Carolina Code 38-71-2110
  • Maximum allowable cost: means the maximum amount that a pharmacy benefit manager will reimburse a pharmacist or pharmacy for the cost of a generic drug. See South Carolina Code 38-71-2110
  • Negotiate: means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning substantive benefits, terms, or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance from insurers for purchasers. See South Carolina Code 38-1-20
  • Pharmacy benefit manager: means an entity that contracts with pharmacists or pharmacies on behalf of an insurer, third party administrator, or the South Carolina Public Employee Benefit Authority to:

    (a) process claims for prescription drugs or medical supplies or provide retail network management for pharmacies or pharmacists;

    (b) pay pharmacies or pharmacists for prescription drugs or medical supplies; or

    (c) negotiate rebates with manufacturers for drugs paid for or procured as described in this section. See South Carolina Code 38-71-2110

(1) "Claim" means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device.

(2) "Insurer" means an entity that provides health insurance coverage in this State as defined in Section 38-71-670(7) and Section 38-71-840(16).

(3) "Pharmacist" has the same meaning given that term in Section 40-43-30(65).

(4) "Pharmacy" has the same meaning given that term in Section 40-43-30(67).

(5) "Pharmacy benefit manager" means an entity that contracts with pharmacists or pharmacies on behalf of an insurer, third party administrator, or the South Carolina Public Employee Benefit Authority to:

(a) process claims for prescription drugs or medical supplies or provide retail network management for pharmacies or pharmacists;

(b) pay pharmacies or pharmacists for prescription drugs or medical supplies; or

(c) negotiate rebates with manufacturers for drugs paid for or procured as described in this section.

(6) "List" means the list of drugs for which a pharmacy benefit manager has established a maximum allowable cost.

(7) "Maximum allowable cost" means the maximum amount that a pharmacy benefit manager will reimburse a pharmacist or pharmacy for the cost of a generic drug.

(8) "Network providers" means those pharmacists and pharmacies who provide covered health care services or supplies to an insured or a member pursuant to a contract with a network plan to act as a participating provider.

(B) This article does not apply to the South Carolina Department of Health and Human Services in the performance of its duties in administering Medicaid under Titles XIX and XXI of the Social Security Act.