Panel hears patient and pharmacy testimony calling for PBM reform and stronger oversight

An ad hoc Medical, Military, Public and Municipal Affairs committee heard testimony on PBM (pharmacy benefit manager) practices and 340B program impacts that witnesses said are reducing patient access to specialty medicines and squeezing community pharmacies.

The discussion matters because witnesses described patient harm and financially fragile community providers, while the South Carolina Department of Insurance said its current authority and resources limit rapid enforcement or full review of PBM business practices.

Virginia Maxwell, a South Carolina patient who described years of denied prior authorizations and step-therapy delays, told the committee she and family members repeatedly faced denials even after physicians provided required documentation. Maxwell said her family’s specialty medication costs rose from about $6,000 to roughly $33,000 per dose and that manufacturer copay assistance previously counted toward her deductible was being removed by PBM practices, leaving her with an out-of-pocket maximum of about $16,000. Maxwell said those changes forced her to consider moving out of state if copay accumulators are not addressed. “They still have the right to deny that,” Maxwell said of the prior-authorization process.

Katie Scanlon, senior director of pharmacy…