A group of Georgia lawmakers went into the 2020 session looking for ways to reduce the cost of prescriptions and improving regulations on pharmacy benefits managers (PBMs) that operate in the state. One of those legislators was Rep. David Knight (R-Griffin), who listed this as a top priority.
Speaking to his colleagues during the session, Knight urged voters to support two bills that would accomplish that goal — “We want to take healthcare back in Georgia and we will. Today we are saying that we won’t take this in Georgia anymore.”
A majority of the House responded and supported Knight. And late last week, Governor Brian Kemp signed House bills 918 and 946 into law this week.
“Through these two critical legislative measures, Georgia will now have some of the toughest laws regarding how pharmacy benefit managers operate,” said Rep. Knight. “These bills help the state ensure that Georgians are receiving their prescriptions at fair and competitive prices, as well as reducing the burden PBMs place on taxpayer funds. I am proud of the Georgia House Majority Caucus’ work to make drastic improvements to better regulate how PBMs operate in our state, while safeguarding Georgians, especially during this economic and public health crisis.”
Limits for pharmacy benefit managers was also one of the early-session priorities listed by Lt. Governor Geoff Duncan and the Majority Leaders of the Senate.
According to Knight, one of the bills signed into law, will create transparency for prescription drug prices and allow the state to better oversee pharmacy benefits managers. Under House Bill 946, physicians who are employed or contracted by a PBM can only provide advice within a specialty that they have worked in for the past five years.
Additionally, as part of this legislation, when the Department of Community Health (DCH) enters into PBM contracts, the department is encouraged to require the use of a licensed Georgia physician for prior authorization, step therapy appeals or determination reviews for contracts and amendments entered into with a PBM. DCH also has authority over PBM audits that affect those enrolled in Medicaid and state benefit plans. These measures also update the PBM price reporting process, which is the heart of this bill. The bill restricts PBMs from charging an insurance company more for a drug than it cost from a pharmacy and would increase transparency and help manage drug costs, Knight said.
An important aspect of the bill, according to Knight, is patient protections — including strengthening anti-steering laws, requiring that accepted copay assistance be applied to patient plan deductibles and prohibiting PBMs from withholding coverage for lower cost therapeutically equivalent drugs.
The second bill signed into law — House Bill 918 — amends “The Pharmacy Audit Bill of Rights” and placed limitations on the size and frequency of pharmacy audits by PBMs, which Knight says, PBMs currently use as a way to recapture money from pharmacists around the state.