What is the law on prescription drug coverage?

In South Carolina, prescription drug coverage is mandated as part of an individual’s health insurance policy. All policies, whether they be purchased on the state health insurance exchange or privately, must offer coverage for generic and name brand drugs prescribed by a licensed healthcare provider. The Affordable Care Act (ACA) requires that all health plans cover certain types of prescription drugs, including those necessary to treat chronic conditions or prevent serious illnesses. Additionally, the ACA has set limits on the amount a person must pay out-of-pocket for certain categories of drugs as well as put caps on the amount of income a person has to spend on prescription drugs. However, not all drugs are covered and some policies may require the policyholder to pay more than the prescription drug costs at the point of sale. Often policyholders must pay a certain percentage of the cost of each drug, known as coinsurance or copay. In some cases, plans may also require a deductible that must be met before any drug coverage will kick in. In South Carolina, as in all states, individuals with greater drug costs may benefit from purchasing a higher tier health insurance plan as this will afford them more comprehensive coverage for prescription drugs. It is important to speak with an insurance agent or healthcare provider to determine which plan is best for each individual.

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What is the law on prescription drug coverage?

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