§ 33-64-4. Pharmacy Benefits Manager Shall Not Engage in the Practice of Medicine; Recommended Use of Licensed Physician
No pharmacy benefits manager shall engage in the practice of medicine, except as otherwise provided in subsection (b) of this Code section. Any physician employed by or contracted with a pharmacy benefits manager advising on or making determinations specific to a Georgia insured in connection with a prior authorization or step therapy appeal or determination […]
§ 33-64-5. Audit Requirements Applicable to Pharmacy Benefits Managers
Pharmacy benefits managers, whether licensed pursuant to this chapter or exempt from licensure pursuant to subsection (l) of Code Section 33-64-2, shall be subject to Code Section 26-4-118, “The Pharmacy Audit Bill of Rights,” to the same extent and in the same manner as pharmacies. History. Code 1981, § 33-64-5 , enacted by Ga. L. […]
§ 33-64-6. Pharmacy Benefits Manager Shall Not Have to Be Licensed as an Administrator
A pharmacy benefits manager licensed pursuant to this chapter shall not be required to obtain a license as an administrator pursuant to Article 2 of Chapter 23 of this title to perform any function as a pharmacy benefits manager pursuant to this chapter. History. Code 1981, § 33-64-6 , enacted by Ga. L. 2010, p. […]
§ 33-62-3. Submission of Supporting Documentation; Confidentiality; Disclosure
The statement of actuarial opinion shall be provided with the annual statement in accordance with rules and regulations promulgated by the Commissioner regarding property and casualty annual statement instructions and shall be treated as a public document. Documents, materials, or other information in the possession or control of the department that are considered an actuarial […]
§ 33-64-7. Commissioner’s Authority Over Rules and Regulations
The Commissioner shall enforce the provisions of this chapter and may promulgate rules and regulations to implement the provisions of this chapter to ensure the safe and proper operations of pharmacy benefits managers in this state. In addition to all other authority granted by this title, the Commissioner may: Conduct financial examinations and compliance audits […]
§ 33-63-1. Legislative Findings
The General Assembly finds that guaranteed asset protection waivers are not insurance. All guaranteed asset protection waivers issued on or after the date of enactment of this chapter shall not be construed as insurance. History. Code 1981, § 33-63-1 , enacted by Ga. L. 2008, p. 1097, § 1/SB 470; Ga. L. 2019, p. 533, […]
§ 33-64-8. Electronic Prior Authorization Drug Requests With Health Care Providers
As used in this Code section, “electronic prior authorization” or “e-prior authorization” means a requirement that a prescriber obtain approval via electronic media from a health plan to prescribe a specific medication prior to dispensing. Facsimiles shall not be considered an electronic submission under this Code section except in the event that such electronic media […]
§ 33-63-2. Purpose; Exemptions From Applicability of Chapter; Guaranteed Asset Protection Waivers Exempt From State’s Insurance Laws
The purpose of this chapter is to provide a framework within which guaranteed asset protection waivers are defined and may be offered within this state. This chapter shall not apply to: An insurance policy offered by an insurer under the insurance laws of this state; or A debt cancellation or debt suspension contract being offered […]
§ 33-64-9. Requirements for Use of Maximum Allowable Cost Pricing by Pharmacy Benefits Managers; Appeals; Enforcement Authority
Upon each contract execution or renewal between a pharmacy benefits manager and a pharmacy or between a pharmacy benefits manager and a pharmacy’s contracting representative or agent, such as a pharmacy services administrative organization, a pharmacy benefits manager shall, with respect to such contract or renewal: Include in such contract or renewal the sources utilized […]
§ 33-63-3. Definitions
The following terms are defined for purposes of this chapter and are not intended to provide actual terms required in guaranteed asset protection waivers: “Administrator” means a person, other than an insurer or creditor, that performs administrative or operational functions pursuant to guaranteed asset protection waiver programs. “Borrower” means a debtor, retail buyer, or lessee […]