HB100: HB100 Prescription Drug Consumer Financial Protection Act; enact

25 LC 52 0642 House Bill 100 By: Representatives Douglas of the 78 th, Hawkins of the 27th, Au of the 50th, Prince of the 132nd, Bennett of the 94th, and others A BILL TO BE ENTITLED AN ACT To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to1 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 legislati ve 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 D rug Consumer Financial9 Protection Act."10 SECTION 2.11 The General Assembly finds:12 (1) The citizens of this state frequently rely on state-regula ted commercial insurers to13 secure access to the prescription medicines needed to protect their health;14 H. B. 100 - 1 - 25 LC 52 0642 (2) Commercial insurance plans increasingly require enrollees to bear significant15 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 requirem ents are borne21 disproportionately by enrollees with chronic or debilitating conditions;22 (6) Pharmaceutical manufacturers may offer sizeable rebates, d iscounts, 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 the ir intermediaries to retain28 rebates, discounts, and price concessions that instead should b e 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 woul d 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 Annotate d, 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 H. B. 100 - 2 - 25 LC 52 0642 (1) 'Cost sharing requirement' means a deductible, coinsurance, copayment, or any other41 amount or limitation imposed on an enrollee for a covered presc ription 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 co ntract or agreement;46 contract or agreement with a preferred provider organization; a ccident 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 Retiremen t Income Security Act50 of 1974, 29 U.S.C. Section 1001, et seq.51 (3) 'Insurer' means an accident and sickness insurer, fraterna l benefit society, hospital52 service corporation, medical service corporation, healthcare co rporation, health53 maintenance organization, preferred provider organization, prov ider 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 estim ates 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 ma nufacturer, dispensing64 pharmacy, or other party in connection with the dispensing or a dministration of a65 prescription drug; and66 H. B. 100 - 3 - 25 LC 52 0642 (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 pur suant to Article 1 of72 Chapter 18 of Title 45;73 (B) The health insurance plan for public school teachers estab lished 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 esta blished 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 t he 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 res ult 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 fro m 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 regardin g 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 H. B. 100 - 4 - 25 LC 52 0642 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 in surer may disclose the96 information described therein in accord with a department reque st, an appropriate court97 order, or to a third party that needs such information to perfo rm 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 a pply 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 H. B. 100 - 5 -