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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.The provisions of Section 38-71-2220 in Section 1 (gag clauses) and Section 3 (pharmacy audits, electronic records and documentation) of Act No. 48 took effect upon approval by the Governor. All other provisions of Article 21 take effect on January 1, 2021, including the requirement for PBMs to obtain a license from the Department.
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 the Regulation.
Alert: Bulletin 2020-10 issued 9/15/20
The SCDOI has issued Bulletin 2020-10 to provide a timeline for initial licensure as a PBM.
*All PBMs conducting pharmacy benefit manager services in South Carolina beginning January 1, 2021 must be licensed as a PBM.
| Application Timeline for Pharmacy Benefit Manager Licensure Effective January 1, 2021: |
|---|
| PBM Initial Application Begins October 1, 2020 |
| PBM Initial Application Deadline* December 1, 2020 |
* Applications received after December 1, 2020 may result in a delay in the review process and are not guaranteed to have a license issued by January 1, 2021.
For additional details, please refer to the full text of the bulletin by clicking here.
Initial Application- (Choose one method)
Electronic Submission
- The electronic application may be completed on NIPR.com.
- *The PBM States Specific Requirements Application, additional 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 Application MUST be submitted in addition to the NIPR application or your application may be delayed.
Paper Submission
- Complete Pharmacy Benefit Manager Paper Licensure Application.
- Email completed application and all supporting documents to PBMDept@doi.sc.gov
- The application fee of $1000 can be made by check to the S.C. Department of Insurance and mailed to :
Attn: Office of PBM Oversight
South Carolina Department of Insurance
1201 Main Street, Suite 1000
Columbia, SC 29201
License Renewal
The renewal period is December 1, 2021 through March 1, 2022 and repeats annually.
- The renewal application, state specific requirements application and renewal fee of $500 must be completed on NIPR annually within the filing timeline.
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 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