Bill > HB810

This bill requires Pharmacy Benefit Managers (PBMs), which are companies that manage prescription drug benefits on behalf of health insurers, to reimburse pharmacies for prescription drugs based on specific formulas. Specifically, the final reimbursement amount, after all fees and adjustments are accounted for, must equal the national average drug acquisition cost at the time the drug was dispensed, plus a professional dispensing fee set by the Georgia Medicaid program. If the national average cost isn't available, PBMs must use the wholesale acquisition cost as of January 1, 2026, plus the same dispensing fee. The bill defines "affiliate pharmacy" as a pharmacy with a financial or ownership connection to a PBM, and "rural area" as a county with a population under 35,000, with a "rural pharmacy" being one located in such an area. While this reimbursement formula generally applies, it does not apply to state health plans or Medicaid programs, including managed care. However, PBMs are permitted to reimburse rural pharmacies more than the required amount, but this exception does not extend to affiliate, mail-order, or specialty pharmacies. This legislation is set to take effect on July 1, 2027.

Health and Social Services

https://www.legis.ga.gov/legislation/71509