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GA HB873
Bill
Status
Introduced
2/7/2018
Primary Sponsor
David Knight
Click for details
AI Summary
- Requires insurers and pharmacy benefits managers (PBMs) to publish prescription drug formulary information on public websites by October 1, 2018, including coverage status, tier placement, and prior authorization or step therapy requirements, with updates within 7 days of any formulary change
- Directs the Insurance Commissioner to create a single, standard prior authorization form for prescription drugs, not to exceed 2 pages, developed with input from a newly established Advisory Committee on Uniform Prior Authorization
- Mandates specific response timelines for prior authorization requests: acknowledgment of receipt within 2 calendar days, a decision of approved/denied/incomplete within 4 calendar days, and a decision on resubmitted forms within 2 calendar days
- Imposes fines of not less than $25,000 per occurrence on insurers or PBMs that fail to accept the standard form or meet response deadlines, and creates a private right of action for individuals injured by noncompliance
- Requires insurers and PBMs to honor a prior authorization approved by a preceding insurer or PBM for at least 60 days following a change in an enrollee's health benefit plan
Legislative Description
Prescription Drug Benefits Freedom of Information and Consumer Protection Act; enact
Last Action
House Second Readers
2/12/2018
Full Bill Text
No bill text available