HB654: HB654 Insurance; prohibit insurers from conditioning the payment of any medical test or procedure or prescription drug benefit on prior authorization

Under current practice, insurers, pharmacy benefit managers, and the State Health Benefit Plan can require doctors to get advance approval, called prior authorization, before they will pay for certain tests, procedures, or prescription drugs. This bill would stop that practice for anything already covered under a patient's health plan and prescribed by a licensed healthcare provider. The bill adds new sections to four different parts of Georgia law: general insurance rules, pharmacy benefit manager regulation, physician licensing law, and the law governing the State Health Benefit Plan for state employees. Each section says insurers, pharmacy benefit managers, or the state plan cannot condition payment on any preapproval, prior authorization, or precertification. It also says physicians cannot be required to get such approval for patient care. The changes would take effect when the Governor signs the bill or it becomes law without a signature, and would apply to health plans issued or renewed in Georgia on or after July 1, 2026.

• Bars insurers and third-party administrators from requiring prior authorization before paying for a covered medical test, procedure, or prescription drug prescribed by a licensed provider.
• Bars pharmacy benefit managers from requiring prior authorization before paying for a covered prescription drug under the same conditions.
• States that no physician can be required to get preapproval, prior authorization, or precertification from an insurer regarding patient healthcare.
• Applies the same no-prior-authorization rule to the State Health Benefit Plan that covers Georgia state employees.
• Sets the change to apply to health benefit plans issued, delivered, or renewed in Georgia on or after July 1, 2026.

Health insurers, third-party administrators, pharmacy benefit managers, physicians, and the State Health Benefit Plan that covers Georgia state employees and retirees. Patients with individual or group health coverage in Georgia would also be affected, since covered care could no longer be delayed by prior authorization.

If enacted, Georgians with insurance could get covered tests, procedures, and prescription drugs paid for without waiting on insurer approval, as long as a licensed provider prescribed the care. This would change how quickly patients can access treatment and how insurers and pharmacy benefit managers process claims.

• Section 1 adds O.C.G.A. § 33-24-59.34, prohibiting insurers and third-party administrators from conditioning payment for a covered medical test, procedure, or prescription drug on prior authorization.
• Section 2 adds O.C.G.A. § 33-64-14, applying the same prohibition to pharmacy benefit managers for prescription drug benefits.
• Section 3 adds O.C.G.A. § 43-34-49, stating no physician shall be required to obtain preapproval, prior authorization, or precertification from an insurer regarding patient care.
• Section 4 adds O.C.G.A. § 45-18-4.2, applying the same prohibition to the State Health Benefit Plan for state employees.
• Section 5 sets the effective date as approval by the Governor or becoming law without signature, applying to health plans issued or renewed on or after July 1, 2026.
• Section 6 repeals all conflicting laws.

1. 2025-02-28House Second Readers (House)
2. 2025-02-27House First Readers (House)
3. 2025-02-26House Hopper (House)

• Lisa Campbell (D, HD-035)Primary sponsor
• Michelle Au (D, HD-050)
• David Wilkerson (D, HD-038)
• Jasmine Clark (D, HD-108)
• Anne Westbrook (D, HD-163)

• health insurance
• prior authorization
• pharmacy benefit managers
• medical practice regulation
• state employee health plan