This bill introduces several significant changes to pharmacy services regulation in South Carolina, focusing primarily on Pharmacy Benefits Managers (PBMs) and Medicaid pharmacy services. The bill defines a “low-volume pharmacy” as one dispensing fewer than 65,000 prescriptions in a fiscal year and establishes new reimbursement requirements for PBMs, mandating that they reimburse pharmacies at least 104% of the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee. PBMs are prohibited from reimbursing pharmacies less than they reimburse their own affiliates, and low-volume pharmacies are entitled to an enhanced dispensing fee. The bill also empowers the Department of Insurance to handle complaints about inadequate reimbursement and potentially penalize PBMs. Additionally, the South Carolina Department of Health and Human Services is authorized to directly manage Medicaid pharmacy services or limit PBM involvement, with strict restrictions on transaction fees and spread pricing. The Attorney General is granted the power to take legal action against entities violating these regulations, with the ability to seek injunctions and restore losses to affected parties. These provisions aim to increase transparency, fairness, and cost-effectiveness in pharmacy services, with the changes set to take effect on January 1, 2026, and apply to new, renewed, or amended contracts from that date forward.