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