HB100: HB100 Prescription Drug Consumer Financial Protection Act; enact

Right now, drug manufacturers often give insurers rebates, discounts, or other price concessions tied to the prescription drugs they cover. Insurers are not currently required to share most of that money with the patients who actually take the drugs, so someone's out-of-pocket cost can stay high even though the insurer received a rebate behind the scenes. House Bill 100 would add a new section to Georgia's insurance code (O.C.G.A. Title 33, Chapter 24) requiring insurers to calculate an enrollee's cost sharing, such as a deductible or copay, using a price reduced by at least 80 percent of the rebates the insurer receives for that drug. Insurers that don't comply could face civil penalties or have their license suspended or revoked. The bill also shields the specific rebate amounts insurers receive from public disclosure, treating that information as a trade secret. It would take effect January 1, 2026, and apply to health plans issued or renewed in Georgia on or after that date.

• Requires insurers to reduce an enrollee's cost sharing (deductible, copay, or coinsurance) by at least 80 percent of the rebates the insurer receives for that prescription drug.
• Requires insurers to describe this rebate-based cost sharing calculation in their health benefit plans.
• Allows the state to impose civil penalties or suspend or revoke an insurer's license for failing to comply.
• Classifies insurer-specific rebate amounts as a trade secret, exempting them from Georgia's open records law (O.C.G.A. § 50-18-70) and barring disclosure to nongovernmental parties except in limited cases.
• Sets an effective date of January 1, 2026, applying to policies issued, delivered, or renewed in Georgia on or after that date.

The bill affects Georgians enrolled in state-regulated commercial health insurance plans, including state employee and teacher health plans and the Regents Health Plan, as well as insurers, health maintenance organizations, and pharmacy benefit arrangements that negotiate drug rebates on their behalf.

If passed, patients with health coverage in Georgia could see lower out-of-pocket costs at the pharmacy when their insurer receives a rebate on their prescription drug, since insurers would have to pass most of that rebate value through at the point of sale rather than keeping it.

• Section 1 names the bill the 'Prescription Drug Consumer Financial Protection Act.'
• Section 2 lists legislative findings on high out-of-pocket drug costs and insurers retaining rebate value instead of passing it to enrollees.
• Section 3 adds new Code Section 33-24-59.34, defining terms like 'rebate,' 'cost sharing requirement,' and 'health benefit plan,' and requiring insurers to reduce point-of-sale cost sharing by at least 80 percent of rebates received.
• Section 3(c) authorizes penalties under O.C.G.A. § 33-2-24 or other state laws, including civil penalties and license suspension or revocation, for noncompliance.
• Section 3(e)-(f) makes insurer-specific rebate amounts a trade secret exempt from public records requests, with limited exceptions for department requests, court orders, or third parties performing administrative services.
• Section 4 sets the effective date as January 1, 2026, applying to policies issued or renewed on or after that date.

1. 2025-01-28House Second Readers (House)
2. 2025-01-27House First Readers (House)
3. 2025-01-17House Hopper (House)

• Demetrius Douglas (D, HD-078)Primary sponsor
• Lee Hawkins (R, HD-027)
• Michelle Au (D, HD-050)
• Brian Prince (D, HD-132)
• Karen Bennett (D, HD-094)
• Jasmine Clark (D, HD-108)

• prescription drug costs
• health insurance regulation
• drug rebates
• out-of-pocket costs