Georgia 2025-2026 Regular Session

Georgia House Bill HB100 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	25 LC 52 0642
2	2	House Bill 100
3	3	By: Representatives Douglas of the 78
4	4	th
5	5	, Hawkins of the 27
6	6	th
7	7	, Au of the 50
8	8	th
9	9	, Prince of the
10	10	132
11	11	nd
12	12	, Bennett of the 94
13	13	th
14	14	, and others
15	15	A BILL TO BE ENTITLED
16	16	AN ACT
17	17	To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
18	18	1
19	19	insurance generally, so as to require all health insurers to pass along no less than 80 percent2
20	20	of all prescription drug rebates to enrollees that such insurer receives from third parties with3
21	21	regard to such enrollee's prescription drugs; to provide for definitions; to provide for related4
22	22	matters; to provide for a short title; to provide for legislative findings; to provide for an5
23	23	effective date and applicability; to repeal conflicting laws; and for other purposes.6
24	24	BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7
25	25	SECTION 1.8
26	26	This Act shall be known and may be cited as the "Prescription Drug Consumer Financial9
27	27	Protection Act."10
28	28	SECTION 2.11
29	29	The General Assembly finds:12
30	30	(1) The citizens of this state frequently rely on state-regulated commercial insurers to13
31	31	secure access to the prescription medicines needed to protect their health;14
32	32	H. B. 100
33	33	- 1 - 25 LC 52 0642
34	34	(2) Commercial insurance plans increasingly require enrollees to bear significant
35	35	15
36	36	out-of-pocket costs for their prescription medicines;16
37	37	(3) High out-of-pocket costs of prescription medicines impact the ability of enrollees to17
38	38	start new and necessary medicines and to stay adherent to their prescriptions;18
39	39	(4) High or unpredictable cost sharing requirements are a main driver of unaffordable19
40	40	enrollee out-of-pocket costs;20
41	41	(5) The burdens of high or unpredictable cost sharing requirements are borne21
42	42	disproportionately by enrollees with chronic or debilitating conditions;22
43	43	(6) Pharmaceutical manufacturers may offer sizeable rebates, discounts, and price23
44	44	concessions in connection with the dispensing or administration of a therapy, but24
45	45	enrollees do not necessarily financially benefit from these amounts at the point of sale,25
46	46	and, instead, insurers or other intermediaries may retain the value of rebates, discounts,26
47	47	and price concessions;27
48	48	(7) Restrictions are needed on the ability of insurers and their intermediaries to retain28
49	49	rebates, discounts, and price concessions that instead should be directly passed on to29
50	50	enrollees as cost savings;30
51	51	(8) Enrollees need equitable and accessible health coverage that does not impose unfair31
52	52	cost sharing burdens upon them; and32
53	53	(9) The legislature intends that enrollees receive the benefit of meaningful and durable33
54	54	cost savings from rebates and other price concessions that would otherwise accrue to34
55	55	insurers in connection with the dispensing or administration of a particular drug therapy.35
56	56	SECTION 3.36
57	57	Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance37
58	58	generally, is amended by adding a new Code section to read as follows: 38
59	59	"33-24-59.34.
60	60	39
61	61	(a) As used in this Code section, the term:40
62	62	H. B. 100
63	63	- 2 - 25 LC 52 0642
64	64	(1) 'Cost sharing requirement' means a deductible, coinsurance, copayment, or any other41
65	65	amount or limitation imposed on an enrollee for a covered prescription drug under the42
66	66	enrollee's health benefit plan.43
67	67	(2) 'Health benefit plan' means any hospital, health, or medical expense insurance policy;44
68	68	hospital or medical service contract; employee welfare benefit plan; contract or45
69	69	agreement with a health maintenance organization; subscriber contract or agreement;46
70	70	contract or agreement with a preferred provider organization; accident and sickness47
71	71	insurance benefit plan; state healthcare plan; or other insurance contract under any other48
72	72	name. Such term shall not include self-funded, employer sponsored health benefit plans49
73	73	subject to the exclusive jurisdiction of the Employee Retirement Income Security Act50
74	74	of 1974, 29 U.S.C. Section 1001, et seq.51
75	75	(3) 'Insurer' means an accident and sickness insurer, fraternal benefit society, hospital52
76	76	service corporation, medical service corporation, healthcare corporation, health53
77	77	maintenance organization, preferred provider organization, provider sponsored health54
78	78	care corporation, managed care entity, or any similar entity authorized to issue contracts55
79	79	under this title or to provide health benefit policies.56
80	80	(4) 'Price protection rebate' means a negotiated price concession that accrues directly or57
81	81	indirectly to the insurer, or other party on behalf of the insurer, in the event of an increase58
82	82	in the wholesale acquisition cost of a drug above a specified threshold.59
83	83	(5) 'Rebate' means:60
84	84	(A) Negotiated price concessions, including, but not limited to, base price concessions61
85	85	whether described as a rebate or otherwise and reasonable estimates of any price62
86	86	protection rebates and performance based price concessions that may accrue directly63
87	87	or indirectly to the insurer during the coverage year from a manufacturer, dispensing64
88	88	pharmacy, or other party in connection with the dispensing or administration of a65
89	89	prescription drug; and66
90	90	H. B. 100
91	91	- 3 - 25 LC 52 0642
92	92	(B) Reasonable estimates of any negotiated price concessions, fees, and other67
93	93	administrative costs that are passed through, or are reasonably anticipated to be passed68
94	94	through, to the insurer and serve to reduce the insurer's costs for acquiring a69
95	95	prescription drug.70
96	96	(6) 'State healthcare plan' means:71
97	97	(A) The state employees' health insurance plan established pursuant to Article 1 of72
98	98	Chapter 18 of Title 45;73
99	99	(B) The health insurance plan for public school teachers established pursuant to74
100	100	Subpart 2 of Part 6 of Article 17 of Chapter 2 of Title 20;75
101	101	(C) The health insurance plan for public school employees established pursuant to76
102	102	Subpart 3 of Part 6 of Article 17 of Chapter 2 of Title 20; and77
103	103	(D) The Regents Health Plan established pursuant to authority granted to the board78
104	104	pursuant to Code Sections 20-3-31, 20-3-51, and 31-2-4.79
105	105	(b) An insurer shall calculate the cost sharing requirement of an enrollee for each80
106	106	prescription drug provided through a health benefit plan at the point of sale to the enrollee81
107	107	based on a price that is reduced by an amount equal to at least 80 percent of all rebates82
108	108	received or to be received by such insurer in connection with the dispensing or83
109	109	administration of the prescription drug and shall describe such calculation in such plans.84
110	110	(c) Noncompliance with this Code section by an insurer may result in the imposition of85
111	111	penalties set forth in Code Section 33-2-24 or other state laws, including the imposition of86
112	112	civil penalties and the suspension or revocation of an insurer's license.87
113	113	(d) Nothing in this Code section shall preclude an insurer from decreasing an enrollee's88
114	114	cost sharing requirement.89
115	115	(e) Except as described in subsection (f) of this Code section, neither an insurer nor its90
116	116	agents shall publish or otherwise disclose information regarding the actual amount of91
117	117	rebates that an insurer receives on a product, manufacturer, or pharmacy-specific basis.92
118	118	Such information qualifies as a trade secret pursuant to Code Section 10-1-761 and shall93
119	119	H. B. 100
120	120	- 4 - 25 LC 52 0642
121	121	not be a public record for purposes of Article 4 of Chapter 18 of Title 50 and shall not be94
122	122	disclosed directly or indirectly to any nongovernmental party.95
123	123	(f) Notwithstanding subsection (e) of this Code section, an insurer may disclose the96
124	124	information described therein in accord with a department request, an appropriate court97
125	125	order, or to a third party that needs such information to perform healthcare or98
126	126	administrative services for such insurer. Any nongovernmental party receiving such99
127	127	information shall maintain the confidentiality of such information in accord with this Code100
128	128	section and other applicable law."101
129	129	SECTION 4.102
130	130	This Act shall become effective on January 1, 2026, and shall apply to all policies issued,103
131	131	delivered, issued for delivery, or renewed in this state on or after such date. 104
132	132	SECTION 5. 105
133	133	All laws and parts of laws in conflict with this Act are repealed.106
134	134	H. B. 100
135	135	- 5 -