Frequently Asked Questions

Section 38-71-2200 of the SC Code of Laws, as amended, defines a Pharmacy Benefit Manager as follows:

‘Pharmacy benefits manager’ means an entity that contracts with pharmacists or pharmacies on behalf of an insurer, third party administrator, or the South Carolina Public Employee Benefit Authority to:

       (a)   process claims for prescription drugs or medical supplies or provide retail network management for pharmacies or pharmacists;

       (b)   pay pharmacies or pharmacists for prescription drugs or medical supplies; or

       (c)   negotiate rebates with manufacturers for drugs paid for or procured as described in this article.

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. Regulation 69-77, Pharmacy Benefit Managers, is the new regulation promulgated to implement the provisions of Act No. 48 of 2019 regarding the licensure and regulation of pharmacy benefit managers. 

The PBM license application window is October 1, 2020- December 1, 2020. Detailed instructions for PBM licensure is available on the PBM webpage on the South Carolina Department of Insurance website. PBM licenses will become effective on January 1, 2021.

The PBM will not be authorized to operate in the state of South Carolina until proper licensure is obtained. An unlicensed PBM is subject to a fine of up to $10,000 per violation pursuant to Section 38-2-30 of the S.C. Code of Laws of 1976, as amended.   

No. The PBM Application Requirements Checklist is for internal use only, but can function as a guide for all required documents necessary to obtain a PBM license and to ensure approval is granted in the most efficient manner.

You can access the application and process fee payments via the NIPR website. The required supplemental application can be found on NIPR’s State Specific Requirements page and on the Department’s PBM webpage. Once completed, the application and supporting documents may be uploaded electronically via NIPR’s Attachment Warehouse or emailed directly to the PBM Office's email at PBMDept@doi.sc.gov.  

Once the license becomes active, an email notification will be sent to each entity with a copy of their PBM license. PBMs can also print their license on the StateBasedSystem.com. 

Each entity should review the definition of PBM and make a determination that every function the entity performs falls solely under the PBM license. If the entity performs additional functions that fall outside of the definition of PBM, then the entity may fall outside of the PBM license authority, and the TPA license would be required in addition to the PBM License.

PBMs can complete the PBM Information Change Form and submit it to the Office of PBM Oversight at PBMDept@doi.sc.gov

Pharmacy providers may complete the PBM Complaint Form and email, fax or mail it to the Office of PBM Oversight along with any supporting documentation that would assist in the complaint process. Providers may also complete the Online PBM Complaint Form and submit the form and attach all supporting documents on the SCDOI website. 

Consumers should continue to contact the Office of Consumer Services to file a complaint. Consumer Services can be reached at (803) 737-6180 or you can email your question to consumers@doi.sc.gov.