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A pharmacy benefits manager is a third-party administrator (TPA) of prescription drug programs for insurers and employers who pay a fee to the PBM for their services. PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts with drug manufacturers and rebates, etc. PBMs manage health care plans for commercial insurance plans, self-insured employer plans, Medicare Part D plans, state government employee health plans and Medicaid managed care organization plans.
Yes, there are companies providing PBM services in South Carolina but they are currently licensed as TPAs.
It creates a new PBM license and establishes other requirements for PBMs. It also authorizes the South Carolina Department of Insurance to promulgate regulations to enforce the provisions of the new law.
Yes. The Department plans to start the process for promulgating a new regulation during the Fall of 2019.
Companies are not required to be licensed as PBMs until 2021. In the Fall of 2020, the South Carolina Department of Insurance will post information about the new application process and the timeframe for licensure. PBM licenses will not be effective until January 1, 2021 or after. Until then, PBMs will continue to be licensed and regulated as TPAs.