(For Effective Date, See note.) Commissioner's Authority Over Rules and Regulations

  1. Law
  2. Georgia Code
  3. Insurance
  4. Regulation and Licensure of Pharmacy Benefits Managers
  5. (For Effective Date, See note.) Commissioner's Authority Over Rules and Regulations

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  1. The Commissioner shall enforce the provisions of this chapter and may promulgate rules and regulations to implement the provisions of this chapter to ensure the safe and proper operations of pharmacy benefits managers in this state.
  2. In addition to all other authority granted by this title, the Commissioner may:
    1. Conduct financial examinations and compliance audits of pharmacy benefits managers to ensure compliance with the provisions of this chapter and rules and regulations implemented pursuant to this chapter; provided, however, that such authority shall not extend to financial examination and compliance audits of pharmacy benefits managers' conduct in performing services on behalf of the state health benefit plan pursuant to Article 1 of Chapter 18 of Title 45 or the medical assistance program pursuant to Article 7 of Chapter 4 of Title 49. The pharmacy benefits manager subject to a financial examination or compliance audit shall pay all the actual expenses incurred in conducting the examination or audit. When the examination or audit is made by an examiner or auditor who is not a regular employee of the department, the pharmacy benefits manager examined or audited shall pay the proper expenses for the services of the examiner or auditor and his or her assistants and the actual travel and lodging expenses incurred by such examiners, auditors, and assistants in an amount approved by the Commissioner. The examiner or auditor shall file a consolidated accounting of expenses for the examination or audit with the Commissioner. No pharmacy benefits manager shall pay, and no examiner or auditor shall accept, any additional emolument on account of any examination or audit. When the examination or audit is conducted in whole or in part by regular salaried employees of the department, payment for such services and proper expenses shall be made by the pharmacy benefits manager examined or audited to the Commissioner. The Commissioner shall be authorized to keep a portion of examination or audit fees paid by the pharmacy benefits manager examined or audited to pay for any costs incurred as a result of the examination or audit, and any fees remaining shall be deposited in the state treasury; provided, however, that when a pharmacy benefits manager is examined or audited because of a complaint filed against such pharmacy benefits manager and it is determined by the Commissioner that the complaint was not justified, the expenses incurred as a result of the examination or audit shall not be assessed against the pharmacy benefits manager but shall be borne by the department;
    2. Investigate complaints of alleged violations of this chapter;
    3. Issue cease and desist orders when a pharmacy benefits manager is taking or threatening to take action in violation of this chapter or rules and regulations implemented pursuant to this chapter; and
    4. Order reimbursement to an insured, pharmacy, or dispenser who has incurred a monetary loss as a result of a violation of this chapter or rules and regulations implemented pursuant to this chapter as well as order payment of a fine not to exceed $1,000.00 per violation to an insured, pharmacy, or dispenser who has been aggrieved as a result of a violation of this chapter or rules and regulations implemented pursuant to this chapter. Such fine shall be in addition to and shall not preclude any other fines imposed pursuant to this title. For purposes of this paragraph, a violation shall be considered to have occurred each time a prohibited act is committed.
  3. A pharmacy benefits manager shall make its records available to the Commissioner, deidentified of any protected health information, upon written demand and provide cooperation in connection with financial examinations, compliance audits, and investigations.
  4. In the event a violation of this chapter or rules and regulations implemented pursuant to this chapter is found following a complaint, the Commissioner may, at his or her discretion, conduct a compliance audit to identify whether any other similar violations have occurred within the state.

(Code 1981, §33-64-7, enacted by Ga. L. 2010, p. 757, § 1/SB 310; Ga. L. 2015, p. 337, § 3/HB 470; Ga. L. 2017, p. 494, § 1/HB 276; Ga. L. 2017, p. 497, § 1/SB 103; Ga. L. 2020, p. 768, § 4/HB 946; Ga. L. 2020, p. 780, § 4/SB 313.)

Editor's notes.

- 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 the amendments by these Acts shall apply to all contracts issued, delivered, or issued for delivery in this state on and after July 1, 2017.

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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