Loading chat...
GA SB427
Bill
Status
Introduced
2/24/2020
Primary Sponsor
Jeff Mullis
Click for details
AI Summary
- Requires the Department of Community Health to engage an actuary to complete a study by December 1, 2020, on the fiscal impact of removing pharmacy benefits from Medicaid care management organizations (CMOs) and providing them instead through the state's Medicaid fee-for-service program
- Mandates a pharmacy benefit carve-out effective July 1, 2021, if the actuarial study projects combined state and federal savings of $20 million or more annually, with the department assuming responsibility for pharmacy benefits from CMOs
- Gives the department discretionary authority to proceed with the carve-out if projected savings fall between $10 million and $20 million, considering factors such as transparency, economic benefits, and oversight costs
- Requires CMO contract payments to be reduced by 7.5% of each organization's net underwriting gain for the July 2020–June 2021 contract year to fund the department's pharmacy benefit administration and implementation costs
- Cites legislative concerns including over $50 million in spread pricing differentials, self-dealing between CMOs and affiliated pharmacies, over $499.8 million in CMO administrative expenses in 2018, and Georgia's Medicaid managed care program ranking in the bottom 25th percentile nationally for multiple medication management measures
Legislative Description
Medicaid; actuarial study of the fiscal impact of carving out pharmacy benefits; Department of Community Health; require
Last Action
Senate Read and Referred
2/25/2020
Full Bill Text
No bill text available