HB931: HB931 Health; control high costs of prescription drugs; establish framework

Georgia currently has no state board reviewing whether prescription drug prices are reasonable. HB 931 would add a new article to Title 31 of Georgia law creating a five member Prescription Drug Affordability Board, appointed by the Governor and confirmed by the Senate, housed within the Department of Community Health. The board would identify costly or fast-rising drugs each year starting January 1, 2026, collect pricing data from health benefit plans, and conduct affordability reviews. If a drug is found to pose an affordability challenge, the board could set an upper payment limit on it, which would apply to purchases and insurance reimbursements statewide (ERISA plans could opt in). Manufacturers withdrawing a capped drug from Georgia must give six months notice or face a penalty up to $500,000. The board must report annually to state officials and legislative committees. The bill also adds a requirement that indigent care trust fund programs negotiate specialist rates. It would take effect immediately upon the Governor's signature.

• Creates a five member Prescription Drug Affordability Board appointed by the Governor and confirmed by the Senate, housed within the Department of Community Health.
• Requires the board to annually identify high cost or fast rising prescription drugs starting January 1, 2026, using cost thresholds like a $3,000 yearly wholesale price or large price increases.
• Authorizes the board to conduct affordability reviews of flagged drugs and, if it finds an affordability challenge, to set an upper payment limit that applies to purchases and insurance reimbursements statewide.
• Requires health benefit plans to report detailed drug spending and rebate data to the board each year.
• Requires manufacturers to give six months notice before pulling a price-capped drug from the Georgia market or face a fine of up to $500,000.
• Requires indigent care trust fund programs that support rural healthcare providers to negotiate specialist care rates with primary healthcare programs.

Georgians who buy prescription drugs, health insurers and health benefit plans, pharmacy benefits managers, drug manufacturers and wholesale distributors, state agencies that purchase drugs, hospitals and healthcare providers serving indigent patients, and ERISA-governed employer health plans that choose to opt in.

If enacted, the board's price caps could directly lower what insurers and consumers pay for certain expensive drugs in Georgia, while manufacturers would face new reporting duties, potential price limits, and penalties for pulling capped drugs from the state without notice.

• Section 1 lays out legislative findings that high prescription drug costs threaten Georgians' health, economic well-being, and the state's ability to fund public programs.
• Section 3 creates new O.C.G.A. Article 2 of Chapter 2, Title 31, establishing the board's membership, terms, conflict of interest rules, open meetings requirements, and authority to assess fees on manufacturers, health plans, and distributors (O.C.G.A. § 31-2-31).
• O.C.G.A. § 31-2-32 sets the criteria for identifying drugs for review, including a $3,000 annual wholesale cost threshold or a 200 percent price increase in 12 months.
• O.C.G.A. §§ 31-2-33 and 31-2-34 describe what data and factors the board can use in affordability reviews, including market competition, patient assistance programs, and health equity impacts.
• O.C.G.A. § 31-2-35 lets the board set upper payment limits by rule, which take effect six months after adoption and can be suspended during drug shortages not caused by the manufacturer.
• O.C.G.A. § 31-2-37 requires manufacturers to give six months notice before withdrawing a capped drug from Georgia, with penalties up to $500,000 for failing to do so.
• O.C.G.A. § 31-2-39 requires the board to submit an annual report to state health officials and legislative committees starting December 1, 2026.
• Section 4 revises O.C.G.A. § 31-8-154 to require rural health provider support programs to negotiate specialist care rates with primary healthcare programs.

1. 2026-01-12House Second Readers (House)
2. 2025-04-04House First Readers (House)
3. 2025-04-04House Hopper (House)

• Karen Lupton (D, HD-083)Primary sponsor
• Marvin Lim (D, HD-098)

• prescription drug prices
• healthcare costs
• health insurance regulation
• drug affordability board
• Medicaid and indigent care