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