Bill
Bill > HB654
GA HB654
Insurance; prohibit insurers from conditioning the payment of any medical test or procedure or prescription drug benefit on prior authorization
summary
Introduced
02/26/2025
02/26/2025
In Committee
Crossed Over
Passed
Dead
Introduced Session
2025-2026 Regular Session
Bill Summary
AN ACT To amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to general provisions regarding insurance, so as to prohibit insurers or third-party administrators from conditioning the payment of any medical test or procedure or prescription drug benefit on prior authorization; to amend Chapter 64 of Title 33 of the Official Code of Georgia Annotated, relating to regulation and licensure of pharmacy benefit managers, so as to prohibit pharmacy benefit managers from conditioning the payment of any benefit for a prescription drug on prior authorization; to amend Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to medical practice, so as to provide that a physician shall not be required to obtain any prior authorization in their exercise of patient healthcare; to amend Part 1 of Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to state employees' health insurance plan, so as not to condition the payment of any medical test or procedure or prescription drug benefit on prior authorization; to provide for definitions; to provide for related matters; to provide for an effective date and applicability; to repeal conflicting laws; and for other purposes.
AI Summary
This bill prohibits insurers, third-party administrators, and pharmacy benefit managers from requiring prior authorization for medical tests, procedures, or prescription drugs that are already covered under a health benefit plan and prescribed by a licensed healthcare provider. Specifically, the bill amends multiple sections of Georgia's legal code to prevent insurance companies and related entities from conditioning payment on preapproval or precertification, effectively streamlining the healthcare process for patients and physicians. The bill defines a "health benefit plan" broadly to include various types of health insurance plans and applies to individual and group policies. Additionally, the bill explicitly states that physicians cannot be required to obtain prior authorization for patient healthcare. The legislation will become effective upon gubernatorial approval and will apply to all health benefit plans issued or renewed on or after July 1, 2026, marking a significant change in how medical services and prescriptions are approved and paid for in Georgia.
Committee Categories
Business and Industry
Sponsors (5)
Michelle Au (D)*,
Lisa Campbell (D)*,
Jasmine Clark (D)*,
Anne Westbrook (D)*,
David Wilkerson (D)*,
Last Action
House Second Readers (on 02/28/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.legis.ga.gov/legislation/70853 |
| BillText | https://www.legis.ga.gov/api/legislation/document/20252026/234043 |
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