Senate introduces PBM transparency bill; rural pharmacists press concerns about reimbursements

Senators introduced legislation intended to regulate pharmacy benefit managers (PBMs) and change reimbursement and transparency standards for pharmacies across South Carolina.

The bill, introduced in the Senate by a bipartisan group of sponsors including Sen. Rankin and others, would: require PBMs to base reimbursements on the national average drug acquisition cost (NADAC) plus a fair dispensing fee; ban spread pricing; allow pharmacies to appeal underpayments to the Department of Insurance; extend PBM regulation to managed-care organizations serving Medicaid; limit the Department of Health and Human Services (DHHS) to hiring no more than two MCO PBMs (or none); and give the state Attorney General authority to enforce the law under the state's unfair trade practices framework.

Senators describing community impact emphasized rural pharmacy closures and low dispensing fees. In floor remarks, a senator who identified himself as a pharmacist-owner described a recent Medicaid claim where the pharmacy was paid $4.21 for a drug and received a 5-cent dispensing fee. He said that his store’s total cost to fill the prescription was roughly $9–$10 and that the tiny dispensing fee meant a net loss on many fills. "They paid us $4.21 for the drug, and they paid us a nickel for a dispensing fee," he told colleagues, using his example to argue for higher, predictable dispensing fees to sustain independent pharmacies in rural and small-town communities.

Supporters said the bill would make reimbursement transparent and consistent; opponents were not recorded on the floor during the introductions. The bill was referred to the Medical Affairs Committee for further review.

Next steps: The Medical Affairs Committee will schedule hearings and vet technical language; pharmacy industry groups and PBMs may testify during committee consideration.