25 LC 46 1006
House Bill 326
By: Representatives Au of the 50
th
, Stephens of the 164
th
, Cooper of the 45
th
, Oliver of the
84
th
, and Hawkins of the 27
th
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated,
1
relating to state employees' health insurance and benefit plans, so as to mandate that the state2
health benefit plan provide coverage for qualifying nonopioid pain management drugs that3
is in parity with its coverage for opioid pain management drugs; to provide for definitions;4
to provide for parity with regard to annual deductibles, coinsurance, copayments, exclusions,5
reductions, other limitations, or utilization review; to provide for legislative construction; to6
provide for related matters; to provide for a short title; to provide for legislative findings; to7
provide for an effective date; to repeal conflicting laws; and for other purposes.8
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9
SECTION 1.10
This Act shall be known and may be cited as the "State Health Benefit Plan Nonopioid11
Coverage Parity Act."12
SECTION 2.13
The General Assembly finds and declares that:14
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(1) An opioid epidemic has cost the state millions of dollars in medical treatment, lost
15
economic productivity, and increased overdose deaths, among other costs; and16
(2) Requiring coverage for nonopioid pain management drugs in the state health benefit17
plan that is at least as good as its coverage for opioid pain management drugs will reduce18
the costs borne by this state. 19
SECTION 3.20
Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to21
state employees' health insurance and benefit plans, is amended by adding a new Code22
section to read as follows:23
"45-18-4.2.
24
(a) As used in this Code section, the term:25
(1) 'Healthcare provider' means the pharmacy, attending physician, or any other person26
or entity administering healthcare to a member of the state health benefit plan at the time27
of reference that is licensed, certified, or otherwise authorized or permitted by law to28
administer healthcare in the ordinary course of business or practice of a profession,29
including any person employed by or acting for any such authorized person or entity.30
(2) 'Prior authorization' means any requirement for the healthcare provider to obtain31
approval from the state health benefit plan prior to the furnishing of a drug.32
(3) 'Qualifying nonopioid pain management drugs' means a drug or biological product33
that:34
(A) Has a label indication approved by the federal Food and Drug Administration to35
reduce postoperative pain or any other form of acute pain;36
(B) Does not act upon the body's opioid receptors;37
(C) Is not a Schedule I or II controlled substance;38
(D) Has been selected by the Department of Community Health for inclusion in its39
formulary; and40
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(E) Is sold or marketed in the United States.41
(4) 'State health benefit plan' means the health insurance plan established pursuant to this42
article.43
(5) 'Step therapy' means a drug therapy utilization management protocol or program that44
requires use of an alternative, preferred prescription drug or drugs before the state health45
benefit plan approves coverage for the nonpreferred drug therapy prescribed.46
(b) The state health benefit plan shall cover qualifying nonopioid pain management drugs47
and such drugs shall be subject to the same annual deductible, coinsurance, copayment,48
exclusions, reductions, or other limitations as to coverage, or utilization review applicable49
to similar covered opioid pain management drugs.50
(c) Notwithstanding subsection (b) of this Code section, nothing in this Code section shall51
be construed to prohibit the state health benefit plan from contracting to provide qualifying52
nonopioid pain management drug coverage for the state health benefit plan that is greater53
than the coverage provided for opioid pain management drugs.54
(d) The state health benefit plan shall, with respect to a qualifying nonopioid pain55
management drug for which coverage is provided under such plan, neither impose any step56
therapy requirement under which an individual enrolled under such plan is required to use57
an opioid pain management drug prior to receiving the prescribed qualifying nonopioid58
pain management drug nor require prior authorization for qualifying nonopioid pain59
management drugs unless similar prior authorization is required for opioid pain60
management drugs.61
(e) Nothing in this Code section should be construed to interfere with the ability of a62
healthcare provider to prescribe or administer a course of treatment that is medically63
appropriate."64
SECTION 4.65
This Act shall become effective on January 1, 2026.66
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SECTION 5.
67
All laws and parts of laws in conflict with this Act are repealed.68
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