STATUS INFORMATION
House Bill 3964 (Read The Full Bill)
Sponsors:
Representative Kevin Hardee (R-105)
Representative Carla Schuessler (R-61)
Senate Bill 330 (Read the Full Bill)
Sponsor: Senator Michael Gambrell (R-4)
Currently residing in the House:
Referred to Committee on Labor, Commerce, and Industry
Summary: Pharmacy Benefits
A BILL TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY ADDING SECTIONS 38-71-292 AND 38-71-820 BOTH SO AS TO DEFINE TERMS AND OUTLINE THE APPLICABILITY AND REQUIREMENTS FOR COST SHARING FOR INSURERS; BY ADDING SECTION 38-71-2270 SO AS TO DEFINE TERMS AND OUTLINE THE APPLICABILITY AND REQUIREMENTS FOR COST SHARING FOR PHARMACY BENEFIT MANAGERS; AND BY AMENDING SECTION 38-71-2200, RELATING TO DEFINITIONS, SO AS TO MAKE CONFORMING CHANGES.
Co-Sponsors
REPUBLICAN
Rep. Kevin Hardee (R-105th)
Rep. Carla Schuessler (R-61st)
Rep. Timothy McGinnis (R-56th)
Rep. Heath Sessions (R-46th)
Rep. William Bailey (R-104th)
Rep. Bruce Bannister (R-24th)
Rep. Phillip Bowers (R-3rd)
Rep. Gary Brewer (R-114th)
Rep. Case Brittain (R-107th)
Rep. Mike Burns (R-17th)
Rep. Joe Bustos (R-112th)
Rep. Paula Calhoun (R-87th)
Rep. Micah Caskey IV (R-89th)
Rep. Don Chapman (R-8th)
Rep. Neal Collins (R-5th)
Rep. Bill Chumley (R-35th)
Rep. Bobby Cox (R-21st)
Rep. Brandon Cox (R-92nd)
Rep. Heather Ammons Crawford (R-68th)
Rep. Sylleste Davis (R-100th)
Rep. Shannon Erickson (R-124th)
Rep. Craig Gagnon (R-11th)
Rep. Gill Gatch (R-94th)
Rep. Daniel Gibson (R-12th)
Rep. Doug Gilliam (R-42nd)
Rep. Brandon Guffey (R-48th)
Rep. Val Guest (R-106th)
Rep. Bill Hager (R-122nd)
Rep. Tom Hartnett, Jr. (R-110th)
Rep. Bill Herbkersman (R-118th)
Rep. Lee Hewitt (R-108th)
Rep. David Hiott (R-4th)
Rep. Bill Hixon (R-83rd)
Rep. Harriet Holman (R-102nd)
Rep. Jeff Johnson (R-58th)
Rep. Jay Jrdan (R-63rd)
Rep. Jay Kilmartin (R-85th)
Rep. Kathy Landing (R-80th)
Rep. Brian Lawson (R-30th)
Rep. Randy Ligon (R-43rd)
Rep. Phillip Lowe (R-60th)
Rep. John McCravy III (R-13th)
Rep. Cody Mitchell (R-65th)
Rep. Brandon Newton (R-45th)
Rep. Weston Newton (R-120th)
Rep. Melissa Lackey Oremus (R-84th)
Rep. Jordan Pace (R-117th)
Rep. Fawn Pedalino (R-64th)
Rep. Tommy Pope (R-47th)
Rep. Robbie Robins (R-97th)
Rep. Blake Sanders (R-9th)
Rep. Mark Smith (R-99th)
Rep. James Teeple (R-116th)
Rep. David Vaughn (R-27th)
Rep. Bill Whitmire (R-1st)
Rep. Chris Wooten (R-69th)
Rep. Richie Yow (R-53rd)
DEMOCRAT
Rep. John King (D-49th)
Rep. Jermaine Johnson (D-52nd)
Rep. Terry Alexander (D-59th)
Rep. Carl Anderson (D-103rd)
Rep. Lucas Atkinson (D-57th)
Rep. Heather Bauer (D-75th)
Rep. William Clyburn (D-82nd)
Rep. Gilda Cobb-Hunter (D-95th
Rep. Chandra Dillard (D-23rd
Rep. Kambrell Garvin (D-77th)
Rep. Wendell Gilliard (D-111th)
Rep. Hamilon Grant (D-79th)
Rep. Jackie Hayes (D-55th)
Rep. Lonnie Hosey (D-91st)
Rep. Wendell Jones (D-25th)
Rep. Roger Kirby (D-101st)
Rep. Jason Luck (D-54th)
Rep. Annie McDaniel (D-41st)
Rep. Michael Rivers (D-121st)
Rep. Tiffany Spann-Wilder (D-109th)
Rep. David Weeks (D-51st)
Rep. Elizabeth Spencer Wetmore (D-115th)
Rep. Robert Williams (D-62nd)
The Problem
In the commercial health insurance market, some patients are being forced to pay more out-of-pocket for their medicines due to an increase in deductibles and the use of coinsurance instead of copays. Deductibles require patients to pay in full for their medicines before insurance coverage kicks in. And unlike copays, which are a fixed dollar amount charged per prescription, coinsurance requires patients to pay a percentage of the medicine’s price.
The Solution – Make All Copays Count
To help patients better access their medicine and stay adherent, many third-party entities, including pharmaceutical manufacturers, offer cost-sharing assistance. Historically, commercial health insurance plans counted this assistance towards a patient’s deductible and maximum out-of-pocket, providing relief from high-cost sharing and making it easier for patients to get their medicines.
South Carolina should enact a law to protect patients who rely on third-party cost-sharing assistance by ensuring that all payments – made by the patient or on behalf of the patient – count towards the patient’s deductible and out-of-pocket maximum. Sixteen states, including neighboring Georgia, North Carolina, and Virginia, have already enacted legislation to address this issue.
Unfortunately, health insurers and PBMs have adopted Polices, often referred to as “accumulator adjustment programs” that block assistance towards a patient’s deductible and maximum out-of- pocket limits CoPay Assistance.
The following groups have committed to advocate on behalf of SC H.3934
-AHUS Action Network
-Aimed Alliance
-ALS Association
-American Cancer Society Cancer Action Network
-American Diabetes Association
-Association for Clinical Oncology (ASCO)
-Arthritis Foundation
-Bleeding Disorders Association of South Carolina
-Coalition of State Rheumatology Organizations
-Community Oncology Alliance (COA)
-Everylife Foundation for Rare Diseases
-Gaucher Community Alliance
-Hemophilia Federation of America
-International Foundation for AiArthritis
-James R. Clark Memorial Sickle Cell Foundation
-LD Barksdale
-Lupus & Allied Diseases Association, Inc.
-Multiple Sclerosis Association of America
-National Alliance on Mental Illness – SC Chapter
-National Bleeding Disorders Foundation
-National Eczema Association
-National Multiple Sclerosis Society
-National Psoriasis Foundation
-Orangeburg Area Sickle Cell Anemia Foundation, Inc.
-SC Oncology Society (SCOC)
-South Carolina Advocates for Epilepsy
-Spondylitis Association of America
-wAIHA Warrio
Additional Resources
