What PBMs Do
PBMs can shape coverage, pricing, and pharmacy access.
They decide which drugs are covered, set patient cost-sharing rules, and influence where prescriptions can be filled.
Affordable Medications for every
South Carolinian
South Carolinian
South Carolina PBM Reform Starts With Transparency
Prescription drug prices are squeezing South Carolina families, especially seniors, working parents, and people managing chronic conditions.
Pharmacy Benefit Managers, also known as PBMs, can influence what you pay, where you can fill prescriptions, and whether your local pharmacy can stay open.
When medicine costs more, people skip doses, delay care, or walk away from treatment.
It is time for South Carolina lawmakers to act.
- PBMs influence what medications are covered, how much you pay, and where you can fill prescriptions.
- Reform protects pharmacy choice and improves transparency.
Why South Carolina Needs Reform
Prescription drug costs remain unacceptably high
If you have ever been surprised by a price at the pharmacy counter or told you have to switch pharmacies, PBM policies may be part of the reason. Prescription drug prices continue rising faster than inflation, burdening patients and employers alike. High costs can lead to skipped doses, delayed care, and worse health outcomes, increasing total healthcare spending for everyone.
Sources: New York Times investigation · FTC interim staff report
PBM middlemen are a significant part of the problem
What is a PBM? A pharmacy benefit manager (PBM) is a company that administers prescription drug benefits for health plans and employers, often setting rules that affect coverage, pricing, and pharmacy access.
PBMs were created to help manage prescription benefits and lower costs. Today, these intermediaries control large parts of the drug supply chain, often with little or no transparency. They influence what medications are covered by insurance, where patients are steered to get their prescriptions, and what pharmacies are paid for dispensing medications.
Example: The same medicine can be priced one way for your insurance plan, but cost something entirely different at the counter – without a clear explanation why.
- Higher out-of-pocket costs
Patients can pay more than they should for essential medications. - Fewer choices at the pharmacy counter
PBMs can steer patients to mail-order or corporate-owned pharmacies instead of local options. - Independent pharmacies under strain
Some reimbursements fall below the cost of the medication and the professional service required to dispense it. - Reduced access in rural communities
Closures contribute to “pharmacy deserts,” making it harder for seniors and vulnerable residents to get care close to home.
What PBM reform could mean for South Carolinians
Commonsense PBM reforms can:
- Make pricing transparent
Patients and employers deserve clarity about how prescription costs are set and where the money goes. - Protect your pharmacy choice
You should be able to fill prescriptions where you choose, especially at the local pharmacy you trust. - Stop hidden practices that inflate costs
Accountability helps ensure savings reach patients and plan sponsors, not just middlemen. - Keep community pharmacies open
Independent pharmacies are healthcare anchors in small towns and neighborhoods. Reform helps preserve access.
Frequently Asked Questions
Why It Matters
PBM policies can affect what you pay and how quickly you get your medicine.
Network restrictions and pricing rules can limit choice and create unexpected costs at the pharmacy counter.
Reform Works
Other states have acted and have gotten results.
States like Ohio, Kentucky, and Georgia have seen millions of dollars in savings as a result of PBM reform legislation.
Learn more: APhA Overview of State PBM Regulation in 2025
Is this about politics?
No. It is about affordability and access.
Rising drug costs hit families, seniors, employers, and small businesses across South Carolina.
Learn More
Find out how PBM practices cost patients, taxpayers, and small businesses.
New York Times: Investigation into PBMs and prescription drug costs
FTC: Interim staff report on prescription drug middlemen (PBMs)
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The South Carolina Legislature is currently considering two PBM reform bills, one in the Senate and one in the House of Representatives. You can view the bills by clicking the links below:
Prefer email? Contact us at info@palmettorxreform.org.
About Palmetto Prescription Reform
Palmetto Prescription Reform is a South Carolina–focused initiative supporting PBM reforms to help lower prescription costs, protect pharmacy choice, and improve transparency in the prescription marketplace. We work with patients, pharmacists, employers, and advocates to advance practical reforms that put people ahead of massive corporate middlemen.