Loading chat...
GA HB1128
Bill
Status
Introduced
3/5/2020
Primary Sponsor
Samuel Park
Click for details
AI Summary
- Establishes minimum pharmacy reimbursement rates by pharmacy benefits managers (PBMs), set at the lowest of: the National Average Drug Acquisition Cost (NADAC) plus a $10.49 dispensing fee, the pharmacy's acquisition cost plus a $10.49 dispensing fee, or the pharmacy's usual and customary charge — and prohibits PBMs from reimbursing pharmacies less than they reimburse themselves or affiliates for the same drug or service
- Requires PBMs to maintain reasonably adequate and accessible pharmacy networks as determined by the Insurance Commissioner, excluding mail-order pharmacies from network adequacy calculations, with failure resulting in license suspension or revocation
- Imposes a fiduciary duty on PBMs toward covered entities they contract with, requiring written disclosure of any conflicts of interest that interfere with that duty
- Prohibits PBMs and third parties from discriminating against 340B drug discount program entities, including through lower reimbursement rates, exclusion from networks, or interfering with patient choice, and creates a private cause of action for violations
- Requires PBM contracts under the state health benefit plan to include quarterly reporting to the board on pharmacy claims data — including amounts paid to pharmacies, dispensing fees, copayments, and amounts charged to the plan sponsor — with a report to the Governor and General Assembly due by December 1, 2020, and contract termination as the penalty for noncompliance
Legislative Description
Insurance; pharmacy benefits managers; revise provisions relating to rules and regulations
Last Action
House Second Readers
3/10/2020
Full Bill Text
No bill text available