(Effective July 1, 2021) Legislative Findings; Surcharges and Reporting on Steering or Imposing Point-of-Sale Fees or Retroactive Fees

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  2. Georgia Code
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  4. Regulation and Licensure of Pharmacy Benefits Managers
  5. (Effective July 1, 2021) Legislative Findings; Surcharges and Reporting on Steering or Imposing Point-of-Sale Fees or Retroactive Fees

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  1. The General Assembly finds that:
    1. The practice of steering by a pharmacy benefits manager represents a conflict of interest;
    2. The practice of imposing point-of-sale fees or retroactive fees obscures the true cost of prescription drugs in this state;
    3. These practices have resulted in harm, including increasing drug prices, overcharging insureds and payors, restricting insureds' choice of pharmacies and other dispensers, underpaying community pharmacies and other dispensers, and fragmenting and creating barriers to care, particularly in rural Georgia and for patients battling life-threatening illnesses and chronic diseases; and
    4. Imposing a surcharge on pharmacy benefits managers that engage in these practices in this state may encourage entities licensed under this title and other payors to use pharmacy benefits managers that are committed to refraining from such practices.
    1. A pharmacy benefits manager that engages in the practices of steering or imposing point-of-sale fees or retroactive fees shall be subject to a surcharge payable to the state of 10 percent on the aggregate dollar amount it reimbursed pharmacies in the previous calendar year for prescription drugs for Georgia insureds.
    2. Any other person operating a health plan and licensed under this title whose contracted pharmacy benefits manager engages in the practices of steering or imposing point-of-sale fees or retroactive fees in connection with its health plans shall be subject to a surcharge payable to the state of 10 percent on the aggregate dollar amount its pharmacy benefits manager reimbursed pharmacies on its behalf in the previous calendar year for prescription drugs for Georgia insureds.
    1. By March 1 of each year, a pharmacy benefits manager shall provide a letter to the Commissioner attesting as to whether or not, in the previous calendar year, it engaged in the practices of steering or imposing point-of-sale fees or retroactive fees. The pharmacy benefits manager shall also submit to the Commissioner, in a form and manner and by a date specified by the Commissioner, data detailing all prescription drug claims it administered for Georgia insureds on behalf of each health plan client and any other data the Commissioner deems necessary to evaluate whether a pharmacy benefits manager may be engaged in the practice of steering or imposing point-of-sale fees or retroactive fees. Such data shall be confidential and not subject to Article 4 of Chapter 18 of Title 50, relating to open records; provided, however, that the Commissioner shall prepare an aggregate report reflecting the total number of prescriptions administered by the reporting pharmacy benefits manager on behalf of all health plans in the state along with the total sum due to the state. The Department of Audits and Accounts shall have access to all confidential data collected by the Commissioner for audit purposes.
    2. By March 1 of each year, any other person operating a health plan and licensed under this title that utilizes a contracted pharmacy benefits manager shall provide a letter to the Commissioner attesting as to whether or not, in the previous calendar year, its contracted pharmacy benefits manager engaged in the practices of steering or imposing point-of-sale fees or retroactive fees in connection with its health plans. The health plan shall also submit to the Commissioner, in a form and manner and by a date specified by the Commissioner, data detailing all prescription drug claims its contracted pharmacy benefits manager administered for Georgia insureds and any other data the Commissioner deems necessary to evaluate whether a health plan's pharmacy benefits manager may be engaged in the practice of steering or imposing point-of-sale fees or retroactive fees. Such data shall be confidential and not subject to Article 4 of Chapter 18 of Title 50, relating to open records; provided, however, that the Commissioner shall prepare an aggregate report reflecting the total number of prescriptions administered by the reporting health plan along with the total sum due to the state. The Department of Audits and Accounts shall have access to all confidential data collected by the Commissioner for audit purposes.
  4. By April 1 of each year, a pharmacy benefits manager or other person operating a health plan and licensed under this title shall pay into the general fund of the state treasury the surcharge owed, if any, as contained in the report submitted pursuant to subsection (c) of this Code section.
  5. Nothing in this Code section shall be construed to authorize the practices of steering or imposing point-of-sale fees or retroactive fees where otherwise prohibited by law.

(Code 1981, §33-64-12, enacted by Ga. L. 2020, p. 768, § 8/HB 946; Ga. L. 2020, p. 780, § 8/SB 313.)

Editor's notes.

- Ga. L. 2020, p. 768, § 8/HB 946 and Ga. L. 2020, p. 780, § 8/SB 313, both enacted a Code section designated 33-64-12 and contained identical provisions.

Ga. L. 2020, p. 768, § 9(a)/HB 946 and Ga. L. 2020, p. 780, § 9(a)/SB 313, not codified by the General Assembly, provide that this Code section is applicable to all contracts issued, delivered, or issued for delivery in this state on and after July 1, 2021.


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