Prescription Drug Program Defined; Cost Sharing; Denial of Coverage; Dispensing Fees

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  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Prescription Drug Program Defined; Cost Sharing; Denial of Coverage; Dispensing Fees

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  1. As used in this Code section, the term "prescription drug program" means any individual or group plan, policy, or contract for prescription drug services issued, delivered, issued for delivery, executed, or renewed by an insurer in this state on or after July 1, 2017.
  2. A prescription drug program providing prescription drug coverage in this state shall permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a pharmacy for less than a 30 day supply if the prescriber or pharmacist indicates the fill or refill could be in the best interest of the insured patient or is for the purpose of synchronizing the insured patient's medications.
  3. No prescription drug program providing prescription drug coverage shall deny coverage for the dispensing of any drug prescribed for the treatment of an illness that is made in accordance with a plan among the insured, a practitioner, and a pharmacist to synchronize the refilling of multiple prescriptions for the insured.
  4. No prescription drug program providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees determined by calculation of the days' supply of medication dispensed. Dispensing fees shall be determined exclusively on the total number of prescriptions dispensed.

(Code 1981, §33-24-59.22, enacted by Ga. L. 2017, p. 769, § 1/SB 200; Ga. L. 2019, p. 1056, § 33/SB 52.)

The 2019 amendment, effective May 12, 2019, part of an Act to revise, modernize, and correct the Code, substituted "30 day supply" for "30 days' supply" in the middle of subsection (b).

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2017, Code Section 33-24-59.21, as enacted by Ga. L. 2017, p. 769, § 1/SB 200, was redesignated as Code Section 33-24-59.22.


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