HB326: HB326 State Health Benefit Plan Nonopioid Coverage Parity Act; enact

The State Health Benefit Plan currently is not required to cover nonopioid pain management drugs on the same terms as opioid pain drugs. This bill, called the State Health Benefit Plan Nonopioid Coverage Parity Act, would change that by adding a new section to Georgia law (O.C.G.A. § 45-18-4.3). The bill defines a 'qualifying nonopioid pain management drug' as one approved by the FDA for postoperative or acute pain, that does not act on opioid receptors, is not a Schedule I or II controlled substance, is included in the Department of Community Health's drug formulary, and is sold in the United States. The plan would have to apply the same deductibles, coinsurance, copayments, exclusions, and utilization review to these drugs as it applies to opioid pain drugs. The plan could still offer better coverage for nonopioid drugs if it chooses, and it could not require patients to try an opioid first or get prior authorization for a nonopioid drug unless it requires the same for opioids. The law would take effect January 1, 2027.

• Adds a new Georgia law requiring the State Health Benefit Plan to cover qualifying nonopioid pain management drugs on equal terms with opioid pain drugs.
• Defines which drugs count as 'qualifying nonopioid pain management drugs' based on FDA approval, chemical action, controlled substance status, and inclusion in the state's drug formulary.
• Bars the plan from requiring patients to try an opioid before receiving a covered nonopioid drug (a practice called step therapy).
• Bars the plan from requiring prior authorization for nonopioid pain drugs unless it requires the same for similar opioid pain drugs.
• Allows the plan to offer even better coverage for nonopioid pain drugs than for opioid drugs if it chooses to.
• Sets the effective date as January 1, 2027, and repeals any conflicting state laws.

State employees, retirees, and other members enrolled in the State Health Benefit Plan; pharmacies and physicians who prescribe pain medications to plan members; and the Department of Community Health, which selects drugs for the plan's formulary.

Members of the State Health Benefit Plan could get easier and more equal access to nonopioid pain medications after surgery or for acute pain, without facing extra costs, step therapy requirements, or prior authorization hurdles that don't also apply to opioid drugs.

• Section 1 names the bill the 'State Health Benefit Plan Nonopioid Coverage Parity Act.'
• Section 2 states the General Assembly's findings that the opioid epidemic has cost Georgia money and that nonopioid coverage parity could reduce those costs.
• Section 3 adds new Code section 45-18-4.3, defining key terms including 'qualifying nonopioid pain management drugs,' 'prior authorization,' and 'step therapy.'
• Subsection (b) requires the plan to cover qualifying nonopioid drugs with the same deductibles, coinsurance, copayments, exclusions, and review as opioid pain drugs.
• Subsection (c) allows the plan to provide even greater coverage for nonopioid drugs than for opioids.
• Subsection (d) prohibits requiring step therapy through opioids first or extra prior authorization for nonopioid drugs unless matched for opioids.
• Subsection (e) clarifies the law does not limit a healthcare provider's ability to prescribe medically appropriate treatment.
• Section 4 sets the effective date as January 1, 2027.

1. 2026-02-24House Committee Favorably Reported By Substitute (House)
2. 2025-02-11House Second Readers (House)
3. 2025-02-10House First Readers (House)
4. 2025-02-06House Hopper (House)

• Michelle Au (D, HD-050)Primary sponsor
• Ron Stephens (R, HD-164)
• Sharon Cooper (R, HD-045)
• Mary Oliver (D, HD-084)
• Lee Hawkins (R, HD-027)

• opioid epidemic
• state employee health insurance
• pain management drugs
• health insurance coverage parity
• State Health Benefit Plan