Georgia 2025-2026 Regular Session

Georgia House Bill HB654 Compare Versions

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

Old	New	Differences
1	1	25 LC 46 1138
2	2	House Bill 654
3	3	By: Representatives Campbell of the 35
4	4	th
5	5	, Au of the 50
6	6	th
7	7	, Wilkerson of the 38
8	8	th
9	9	, Clark of the
10	10	108
11	11	th
12	12	, and Westbrook of the 163
13	13	rd
14	14
15	15	A BILL TO BE ENTITLED
16	16	AN ACT
17	17	To amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,
18	18	1
19	19	relating to general provisions regarding insurance, so as to prohibit insurers or third-party2
20	20	administrators from conditioning the payment of any medical test or procedure or3
21	21	prescription drug benefit on prior authorization; to amend Chapter 64 of Title 33 of the4
22	22	Official Code of Georgia Annotated, relating to regulation and licensure of pharmacy benefit5
23	23	managers, so as to prohibit pharmacy benefit managers from conditioning the payment of any6
24	24	benefit for a prescription drug on prior authorization; to amend Article 2 of Chapter 34 of7
25	25	Title 43 of the Official Code of Georgia Annotated, relating to medical practice, so as to8
26	26	provide that a physician shall not be required to obtain any prior authorization in their9
27	27	exercise of patient healthcare; to amend Part 1 of Article 1 of Chapter 18 of Title 45 of the10
28	28	Official Code of Georgia Annotated, relating to state employees' health insurance plan, so11
29	29	as not to condition the payment of any medical test or procedure or prescription drug benefit12
30	30	on prior authorization; to provide for definitions; to provide for related matters; to provide13
31	31	for an effective date and applicability; to repeal conflicting laws; and for other purposes.14
32	32	BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:15
33	33	H. B. 654
34	34	- 1 - 25 LC 46 1138
35	35	SECTION 1.
36	36	16
37	37	Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to17
38	38	general provisions regarding insurance, is amended by adding a new Code section to read as18
39	39	follows:19
40	40	"33-24-59.34.
41	41	20
42	42	(a) As used in this Code section, the term 'health benefit plan' means any individual or21
43	43	group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,22
44	44	or renewed in this state which provides major medical benefits by a healthcare corporation,23
45	45	health maintenance organization, preferred provider organization, accident and sickness24
46	46	insurer, fraternal benefit society, hospital service corporation, medical service corporation,25
47	47	or other insurer or similar entity.26
48	48	(b) Notwithstanding any provision of law to the contrary, neither an insurer nor a27
49	49	third-party administrator shall condition the payment of any benefit for a medical test or28
50	50	procedure or for a prescription drug upon any preapproval, prior authorization, or29
51	51	precertification of any kind by an insurer if such test, procedure, or prescription drug is30
52	52	otherwise covered under the health benefit plan and such medical test, procedure, or31
53	53	prescription drug has been prescribed by licensed healthcare provider."32
54	54	SECTION 2.33
55	55	Chapter 64 of Title 33 of the Official Code of Georgia Annotated, relating to regulation and34
56	56	licensure of pharmacy benefit managers, is amended by adding a new Code section to read35
57	57	as follows:36
58	58	"33-64-14.37
59	59	(a) As used in this Code section, the term 'health benefit plan' means any individual or38
60	60	group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,39
61	61	or renewed in this state which provides major medical benefits by a healthcare corporation,40
62	62	health maintenance organization, preferred provider organization, accident and sickness41
63	63	H. B. 654
64	64	- 2 - 25 LC 46 1138
65	65	insurer, fraternal benefit society, hospital service corporation, medical service corporation,42
66	66	or other insurer or similar entity.43
67	67	(b) Notwithstanding any provision of law to the contrary, a pharmacy benefit manager44
68	68	shall not condition the payment of any benefit for a prescription drug upon any45
69	69	preapproval, prior authorization, or precertification of any kind by such pharmacy benefit46
70	70	manager, insurer, or purchaser if such prescription drug is otherwise covered under the47
71	71	health benefit plan and such drug has been prescribed by a licensed healthcare provider."48
72	72	SECTION 3.49
73	73	Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to50
74	74	medical practice, is amended by adding a new Code section to read as follows:51
75	75	"43-34-49.52
76	76	No physician shall be required to obtain preapproval, prior authorization, or precertification53
77	77	from an insurer with regard to the healthcare of his or her patients."54
78	78	SECTION 4.55
79	79	Part 1 of Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated,56
80	80	relating to state employees' health insurance plan, is amended by adding a new Code section57
81	81	to read as follows:58
82	82	"45-18-4.2.59
83	83	(a) As used in this Code section, the term 'health benefit plan' means any individual or60
84	84	group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,61
85	85	or renewed in this state which provides major medical benefits by a healthcare corporation,62
86	86	health maintenance organization, preferred provider organization, accident and sickness63
87	87	insurer, fraternal benefit society, hospital service corporation, medical service corporation,64
88	88	or other insurer or similar entity.65
89	89	H. B. 654
90	90	- 3 - 25 LC 46 1138
91	91	(b) Notwithstanding any provision of law to the contrary, the health insurance plan66
92	92	established pursuant to this article shall not condition the payment of any benefit for a67
93	93	medical test or procedure or for a prescription drug upon any preapproval, prior68
94	94	authorization, or precertification of any kind if such test, procedure, or prescription drug69
95	95	is otherwise covered under such plan and is prescribed by a licensed healthcare provider."70
96	96	SECTION 5.71
97	97	This Act shall become effective upon its approval by the Governor or upon its becoming law72
98	98	without such approval and shall apply to all health benefit plans issued, delivered, issued for73
99	99	delivery, or renewed in this state on or after July 1, 2026.74
100	100	SECTION 6.75
101	101	All laws and parts of laws in conflict with this Act are repealed.76
102	102	H. B. 654
103	103	- 4 -