Loading chat...
GA SB408
Bill
Status
Introduced
2/21/2014
Primary Sponsor
Earl Carter
Click for details
AI Summary
- Requires pharmacy benefits managers (PBMs) using maximum allowable cost (MAC) pricing to disclose their methodology, sources, and basis in contracts with pharmacies and covered entities, and to update pricing information every seven calendar days
- Establishes criteria for drugs placed on MAC lists, including requiring at least three nationally available therapeutic equivalents, a minimum 10% cost difference between manufacturers, FDA "Orange Book" 'A' rating, and availability from licensed wholesalers without a 14-day or longer unavailability period
- Creates an administrative appeals process allowing pharmacies to contest MAC rates, requiring PBMs to respond in writing within 15 calendar days and to retroactively adjust reimbursements for all network pharmacies if an appeal is successful
- Prohibits PBMs and other licensed insurers from imposing different copayments, deductibles, fees, or benefit limitations on covered individuals who use in-person pharmacies compared to mail service pharmacies, provided the in-person pharmacy accepts the same pricing terms as the mail service pharmacy
- Extends the Pharmacy Audit Bill of Rights to apply to audits conducted by entities licensed by the Commissioner of Insurance and authorizes the Commissioner to enforce those audit provisions
Legislative Description
Pharmacy Benefits Managers; define certain terms; use of maximum allowable cost pricing; impose certain requirements; enforcement
Last Action
Senate Read and Referred
2/24/2014
Full Bill Text
No bill text available