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GA SB313
Bill
AI Summary
- Increases pharmacy benefits manager (PBM) licensing fees from $500 to $2,000 for initial licenses and from $400 to $1,000 for renewals, while raising monetary penalties for violations from up to $5,000 to up to $10,000 per act
- Grants the Insurance Commissioner authority to conduct financial examinations and compliance audits of PBMs, investigate complaints, issue cease and desist orders, and order reimbursement up to $1,000 per violation to aggrieved insureds, pharmacies, or dispensers
- Prohibits PBMs from steering insureds to affiliate pharmacies, imposing point-of-sale or retroactive fees, deriving revenue from pharmacies or insureds for PBM services, and basing drug reimbursement on patient outcome metrics without pharmacy consent, effective July 1, 2021
- Imposes a 10 percent surcharge on PBMs or health plans whose PBMs engage in steering or impose point-of-sale or retroactive fees, calculated on the aggregate dollar amount reimbursed to pharmacies for Georgia insureds in the previous calendar year, payable by April 1 annually to the state general fund
- Requires PBMs to use national average drug acquisition cost as a reimbursement reference point, file reimbursement methodologies with the Commissioner, offer health plans the ability to receive 100 percent of pharmaceutical manufacturer rebates, and report annually on rebates received and the spread between pharmacy reimbursement and health plan charges
Legislative Description
Pharmacy Benefits Managers; regulation and licensure; extensive revisions; provide
Last Action
Effective Date
7/1/2021
Full Bill Text
No bill text available