Bill > HB196

This bill modifies the state health insurance plan's reimbursement process for self-administered drugs by establishing new requirements for pharmacies and insurers. Starting January 1, 2026, insurers must reimburse pharmacies for self-administered drugs using a transparent pricing model based on the national average drug acquisition cost (NADAC), or alternatively a discounted percentage of average wholesale price if NADAC is unavailable. The bill mandates specific professional dispensing fees that differ for chain pharmacies ($10.50) and independent pharmacies ($11.50). The legislation defines key terms like "pharmacy benefits manager" (PBM), "state health plan" (which includes state employees', public school teachers', and university system health insurance plans), and "independent pharmacy". The bill also prohibits insurers from circumventing these reimbursement requirements through prescription drug discount cards or programs, and grants the Commissioner of Insurance enforcement authority to ensure compliance. This legislation aims to create more transparency and fairness in drug reimbursement for state health plan participants by establishing clear, standardized pricing mechanisms for pharmacies.

Business and Industry, Health and Social Services

https://www.legis.ga.gov/legislation/69712