(Effective Until July 1, 2021) Administration of Claims by Pharmacy Benefits Manager

  1. Law
  2. Georgia Code
  3. Insurance
  4. Regulation and Licensure of Pharmacy Benefits Managers
  5. (Effective Until July 1, 2021) Administration of Claims by Pharmacy Benefits Manager

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  1. A pharmacy benefits manager shall administer claims in compliance with Code Section 33-30-4.3 and shall not require insureds to use a mail-order pharmaceutical distributor including a mail-order pharmacy.
  2. A pharmacy benefits manager shall report annually to each client, including but not limited to insurers and payors, the aggregate amount of all rebates that the pharmacy benefits manager received from pharmaceutical manufacturers in connection with claims if administered on behalf of the client and the aggregate amount of such rebates the pharmacy benefits manager received from pharmaceutical manufacturers that it did not pass through to the client.
  3. This Code section shall not apply to:
    1. A care management organization, as defined in Chapter 21A of this title;
    2. The Department of Community Health, as defined in Chapter 2 of Title 31;
    3. The State Health Benefit Plan under Article 1 of Chapter 18 of Title 45; or
    4. Any licensed group model health maintenance organization with an exclusive medical group contract and which operates its own pharmacies which are licensed under Code Section 26-4-110.

(Code 1981, §33-64-10, enacted by Ga. L. 2017, p. 494, § 2/HB 276; Ga. L. 2017, p. 497, § 2/SB 103; Ga. L. 2019, p. 940, § 2/HB 323; Ga. L. 2020, p. 493, § 33/SB 429; Ga. L. 2020, p. 654, § 4/HB 918.)

Editor's notes.

- Ga. L. 2017, p. 494, § 2/HB 276 and Ga. L. 2017, p. 497, § 2/SB 103 both enacted a Code section designated 33-64-10 and containing identical provisions.

Ga. L. 2017, p. 494, § 3/HB 276 and Ga. L. 2017, p. 497, § 3/SB 103, not codified by the General Assembly, provide that this Code section shall apply to all contracts issued, delivered, or issued for delivery in this state on and after July 1, 2017.

Ga. L. 2019, p. 940, § 4/HB 323, not codified by the General Assembly, provides, in part, that this Act shall apply to all contracts issued, delivered, or issued for delivery in this state on and after January 1, 2020.


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