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

25 LC 46 1138 House Bill 654 By: Representatives Campbell of the 35th, Au of the 50th, Wilkerson of the 38th, Clark of the 108th, and Westbrook of the 163rd A BILL TO BE ENTITLED AN ACT To amend Article 1 of Chapter 24 of Title 33 of the Official Co de of Georgia Annotated,1 relating to general provisions regarding insurance, so as to pr ohibit insurers or third-party2 administrators from conditioning the payment of any medical tes t or procedure or3 prescription drug benefit on prior authorization; to amend Chap ter 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 amen d 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 pr ior 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 H. B. 654 - 1 - 25 LC 46 1138 SECTION 1.16 Article 1 of Chapter 24 of Title 33 of the Official Code of Geo rgia 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 pla n' 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 organizatio n, 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, neit her 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, prio r authorization, or29 precertification of any kind by an insurer if such test, proced ure, or prescription drug is30 otherwise covered under the health benefit plan and such medica l 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 pla n' 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 organizatio n, accident and sickness41 H. B. 654 - 2 - 25 LC 46 1138 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 ph armacy benefit manager44 shall not condition t he payment of any benefit for a prescripti on drug upon any45 preapproval, prior authorization, or precertification of any kind by such pharmacy benefit46 manager, insurer, or purchaser if such prescription drug is oth erwise 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 Geo rgia 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 C ode 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 pla n' 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 organizatio n, accident and sickness63 insurer, fraternal benefit society, hospital service corporation, medical service corporation,64 or other insurer or similar entity.65 H. B. 654 - 3 - 25 LC 46 1138 (b) Notwithstanding any provision of law to the contrary, the health insurance plan66 established pursuant to this article shall not condition the pa yment of any benefit for a67 medical test or procedure or for a prescription drug upon any p reapproval, 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 H. B. 654 - 4 -