(For Effective Date, See note.) Pharmacy Benefits Manager Shall Not Engage in the Practice of Medicine; Recommended Use of Licensed Physician

  1. Law
  2. Georgia Code
  3. Insurance
  4. Regulation and Licensure of Pharmacy Benefits Managers
  5. (For Effective Date, See note.) Pharmacy Benefits Manager Shall Not Engage in the Practice of Medicine; Recommended Use of Licensed Physician

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  1. No pharmacy benefits manager shall engage in the practice of medicine, except as otherwise provided in subsection (b) of this Code section.
  2. Any physician employed by or contracted with a pharmacy benefits manager advising on or making determinations specific to a Georgia insured in connection with a prior authorization or step therapy appeal or determination review shall:
    1. Have actively seen patients within the past five years; and
    2. Have practiced in the same specialty area for which he or she is providing advisement within the past five years.
  3. For contracts and amendments entered into with a pharmacy benefits manager on and after July 1, 2021, the department is encouraged to require the use of a licensed Georgia physician for prior authorization or step therapy appeal or determination reviews.

(Code 1981, §33-64-4, enacted by Ga. L. 2010, p. 757, § 1/SB 310; Ga. L. 2020, p. 768, § 3/HB 946; Ga. L. 2020, p. 780, § 3/SB 313.)

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2020, "July 1, 2021" was substituted for "the effective date of this Act" in the middle of subsection (c).

Editor's notes.

- 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, in part, that the amendment by that Act shall apply to all contracts issued, delivered, or issued for delivery in this state on and after July 1, 2021.


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