A pharmacy benefit manager may request that a lower–priced generic and therapeutically equivalent prescription drug be dispensed to a covered individual, as a substitute for a higher–priced prescription drug.

If the substitute prescription drug’s net cost is higher for the covered individual or the third-party payor than the originally prescribed drug, the substitution may be made only for medical reasons that benefit the covered individual.

If a substitution is being requested pursuant to this section, the pharmacy benefit manager must obtain the approval of the prescribing health professional.

Nothing in this section permits the substitution of an equivalent drug product contrary to § 36-11-46.2.

Source: SL 2004, ch 311, § 8; SL 2023, ch 166, § 9.