Advice from the Apothecary: What Patients Should Know About PBM Reform in South Carolina

As we move into 2026, many patients are asking how changes being discussed in Columbia could affect their prescriptions and their local pharmacy. Here’s what you should know about the growing conversation around Prescription Benefit Managers, or PBMs, and why it matters to you.

According to the South Carolina Board of Pharmacy, 117 pharmacies closed across the state between January 2023 and August 2025. Most of those closures occurred in rural and underserved communities, where a single pharmacy often serves as a lifeline for patients who may already face challenges with transportation, income, or access to health care.

One of the biggest factors behind these closures is the role of PBMs. These companies act as middlemen between drug manufacturers, insurance companies, and pharmacies. PBMs determine which medications are covered by insurance plans, how much they will pay for those medications, and which pharmacies patients are allowed — or strongly encouraged — to use.

Today, many PBMs are part of larger corporations that also own insurance companies and their own mail-order or retail pharmacies. This structure can lead to limited transparency, patient steering toward PBM-owned pharmacies, and reimbursement rates that make it increasingly difficult for independent community pharmacies to stay in business.

That’s where current legislation comes in.

In the South Carolina House of Representatives, H.4971 — often called the “Patients Over PBMs” bill — would create a formal complaint and enforcement process when PBMs fail to follow the law. It also includes provisions aimed at ensuring pharmacies are reimbursed at no less than the cost of the medication they dispense, a critical issue for small and rural pharmacies operating on very thin margins.

In the South Carolina Senate, S.342 proposes several patient-focused protections. Among them: PBMs could not reimburse their own pharmacies at higher rates than independent pharmacies, they would be restricted from steering patients to pharmacies they own, and they would be subject to routine audits. The bill also allows the South Carolina Attorney General to take action if PBMs are found to be acting against the public interest.

You may hear claims that reforms like these will automatically increase costs for patients. It’s important to remember that premiums, deductibles, and copays have continued to rise for years under the current system. Supporters of reform argue that greater transparency and accountability are necessary steps to protect both patients and the local pharmacies that serve them.

The most important piece of advice for patients is this: any reform must include strong patient protections. No one should face higher copays or reduced access to needed medications as a result of changes in how PBMs operate. Patients should be able to choose the pharmacy they trust — whether that’s a hometown independent pharmacy or another option that best meets their needs.

Your local pharmacy is more than just a place to pick up prescriptions. It is a source of guidance, preventive care, and personal connection. As lawmakers debate PBM reform in 2026, the goal should remain clear: protecting patient access, supporting fair pharmacy practices, and keeping health care decisions centered on the people who depend on them most — the patients.

Have a question about your prescriptions, insurance changes, or how pharmacy policies may affect you or your family? “Advice from the Apothecary” is here to help. Readers are encouraged to submit topics or questions they would like to see addressed in future columns. Chances are, if you’re wondering about it, someone else is too.