As used in this chapter, the term: “Affiliate pharmacy” means a pharmacy which, either directly or indirectly through one or more intermediaries: Has an investment or ownership interest in a pharmacy benefits manager licensed under this chapter; Shares common ownership with a pharmacy benefits manager licensed under this chapter; or Has an investor or ownership […]
A pharmacy benefits manager shall administer claims in compliance with Code Section 33-30-4.3 and shall not require insureds to use a mail-order pharmaceutical distributor including a mail-order pharmacy. A pharmacy benefits manager shall offer a health plan the ability to receive 100 percent of all rebates it receives from pharmaceutical manufacturers. In addition, a pharmacy […]
A pharmacy benefits manager shall be proscribed from: Prohibiting a pharmacist, pharmacy, or other dispenser or dispenser practice from providing an insured individual information on the amount of the insured’s cost share for such insured’s prescription drug and the clinical efficacy of a more affordable alternative drug if one is available. No pharmacist, pharmacy, or […]
The General Assembly finds that: The practice of steering by a pharmacy benefits manager represents a conflict of interest; The practice of imposing point-of-sale fees or retroactive fees obscures the true cost of prescription drugs in this state; These practices have resulted in harm, including increasing drug prices, overcharging insureds and payors, restricting insureds’ choice […]
To the extent that any provision of this chapter is inconsistent or conflicts with applicable federal law, rule, or regulation, such applicable federal law, rule, or regulation shall apply. History. Code 1981, § 33-64-13 , enacted by Ga. L. 2020, p. 768, § 8/HB 946; Ga. L. 2020, p. 780, § 8/SB 313. Effective date. […]
No person, business entity, or other entity shall act as or hold itself out to be a pharmacy benefits manager in this state, other than an applicant licensed in this state for the kinds of business for which it is acting as a pharmacy benefits manager, unless such person, business entity, or other entity holds […]
Every applicant for a pharmacy benefits manager’s license shall file with the application and shall thereafter maintain in force a bond in the amount of $100,000.00 in favor of the Commissioner executed by a corporate surety insurer authorized to transact insurance in this state. The terms and type of the bond shall be established by […]
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 […]
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. […]
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. […]
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 […]
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 […]
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 […]
Any methodologies utilized by a pharmacy benefits manager in connection with reimbursement pursuant to Code Section 33-64-9 shall be filed with the Commissioner for use in determining maximum allowable cost appeals; provided, however, that methodologies not otherwise subject to disclosure under Article 4 of Chapter 18 of Title 50 shall be treated as confidential and […]
