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Pharmacy Benefit Managers (PBMs)
New S.C. Pharmacy Benefit Manager Law Passes
On May 16, 2019, Governor McMaster signed bill S.359 (Act No. 48), amending the South Carolina Code of Laws by adding Article 21 to Title 38, Chapter 71 (Accident and Health Insurance). Act No. 48 establishes, among other things, a license requirement for pharmacy benefit managers and authorizes the Department of Insurance to enforce the provisions of Article 21.S.C. Code Ann. Regulation 69-77 (Pharmacy Benefit Managers) became final on June 26, 2020. The South Carolina Department of Insurance is charged with the responsibility of enforcing the provisions set forth in this Regulation.
*All PBMs conducting pharmacy benefit manager services in South Carolina beginning January 1, 2021 must be licensed as a PBM.
PBM License Renewal:
Pharmacy Benefit Managers must renew their license annually to continue to operate and be in compliance with Section 38-71-2210 of the SC Code of Laws, as amended.
| PBM License Renewal Period for licenses expiring by March 1, 2022. | |
|---|---|
| Application Window Begins December 1, 2021 | |
| Application Window Closes March 1, 2022 | |
For additional details, please refer to the full text of the bulletin by clicking here.
Initial Application
Electronic Submission
- The electronic application may be completed on NIPR.com.
- *The PBM States Specific Requirements- Initial License Application, in addition to the NIPR Uniform Application, can be found on NIPR State Specific Requirements page.
- All supporting documentation and $1000 application fee can be uploaded and submitted via the NIPR Attachment Warehouse.
- Follow this step-by-step guide to complete electronic application via NIPR.
* The PBM States Specific Requirements- Initial License Application MUST be submitted in addition to the NIPR application or your application may be delayed.
License Renewal
(The renewal period is December 1, 2021 through March 1, 2022 and repeats annually)
Electronic Submission:
- Complete the NIPR Renewal Application and submit fee payment of $500 on NIPR.com
- In addition to the NIPR Renewal Application, you must complete the PBM State Specific Requirements- License Renewal Application
- Submit all supporting documentation and PBM State Specific Requirements- License Renewal Application via NIPR's Attachment Warehouse or email directly to the Office of PBM Oversight at PBMDept@doi.sc.gov
Additional Forms
- PBM Application Requirements Checklist
- PBM Electronic Application Guide
- PBM License Surrender Form
- PBM Change of Information Form
PBM Complaint Process
South Carolina law requires pharmacies to make all reasonable efforts to exhaust a PBM's internal appeal's process or work through their Pharmacy Services Administration Organization (PSAO) prior to submitting unresolved complaints to the South Carolina Department of Insurance (SCDOI). If all efforts have been made to resolve a potential violation, you may follow the steps below to file a complaint with the SCDOI.
To complete the PBM Complaint Form follow the steps below:
Submit via SCDOI Website:
1. Click PBM Complaint Form
2. Complete online form
3. Upload supporting documents directly to online form
4. Click "Submit" when complete
Submit via email:
- Save PBM Complaint Form as a digital PDF document.
- Complete fillable complaint form that was saved as digital PDF document.
- Email completed PBM Complaint Form and any supporting documents to the Office of PBM Oversight at PBMDept@doi.sc.gov..
Submit via fax:
- Complete fillable PBM Complaint Form.
- Print completed PBM Complaint Form.
- Fax completed form and any supporting documents to the Office of PBM Oversight at (803) 737-1605.
Submit via mail:
- Complete fillable PBM Complaint Form.
- Print completed PBM Complaint Form.
- Mail completed form and any supporting documents to
Attn: Office of PBM Oversight
South Carolina Department of Insurance
1201 Main Street, Suite 1000
Columbia, SC 29201