HB 100: Prescription Drug Consumer Financial Protection Act; enact

When insurers negotiate discounts and rebates with drug manufacturers, those savings do not always reach the person filling the prescription. Insurers can keep some or all of that money instead of lowering what enrollees pay in deductibles, copays, or coinsurance. House Bill 100 targets that gap. The bill adds a new section to Georgia's insurance code requiring insurers to calculate an enrollee's out-of-pocket cost for a covered prescription drug based on a price reduced by at least 80 percent of any rebates the insurer receives for that drug. It defines terms like rebate, cost sharing requirement, and health benefit plan, and it exempts self-funded employer plans governed by federal ERISA law. The bill also protects the specific rebate amounts as trade secrets, shielding them from public records requests, though insurers can still share them with regulators, courts, or contractors who need them. The law would apply to policies issued or renewed on or after January 1, 2026.

• Requires insurers to reduce an enrollee's out-of-pocket cost for a prescription drug by at least 80 percent of any rebate the insurer receives for that drug, calculated at the pharmacy counter.
• Requires insurers to describe this rebate-based cost calculation within their health benefit plans.
• Creates civil penalties, including possible license suspension or revocation, for insurers that do not comply, under Georgia's existing insurance penalty law (O.C.G.A. § 33-2-24).
• Classifies the specific dollar amounts of rebates insurers receive as trade secrets, exempting them from Georgia's open records law (O.C.G.A. § 50-18-70) and barring disclosure to most nongovernmental parties.
• Allows insurers to still disclose rebate details to state regulators, under a court order, or to contractors performing administrative services, as long as confidentiality is maintained.
• Sets an effective date of January 1, 2026, applying to insurance policies issued or renewed on or after that date.

Georgia residents enrolled in state-regulated commercial health insurance plans who take prescription drugs, along with the insurers, HMOs, and similar entities that must recalculate cost sharing. Public employees and teachers in Georgia's state health plans are also covered, while people on self-funded employer plans governed by federal ERISA law are excluded.

If enacted, many Georgians could see lower out-of-pocket costs at the pharmacy because insurers would have to pass most rebate money on to patients instead of keeping it. At the same time, the exact size of those rebates would remain shielded from public disclosure as a trade secret.

• Section 1 names the bill the 'Prescription Drug Consumer Financial Protection Act.'
• Section 2 lists legislative findings about high out-of-pocket drug costs and insurers retaining rebate value instead of passing it to enrollees.
• Section 3 adds new Code Section 33-24-59.34, defining 'rebate,' 'cost sharing requirement,' 'insurer,' and other terms, and excluding ERISA self-funded plans.
• Section 3(b) requires insurers to calculate an enrollee's point-of-sale cost using a price reduced by at least 80 percent of rebates received for that drug.
• Section 3(c) ties noncompliance to existing insurance penalties under O.C.G.A. § 33-2-24, including possible license suspension or revocation.
• Section 3(e)-(f) makes specific rebate amounts a protected trade secret exempt from public records law, with limited disclosure allowed to regulators, courts, or service contractors.
• Section 4 sets the effective date as January 1, 2026, for policies issued or renewed on or after that date.

1. 2025-01-28House Second Readers (House)
2. 2025-01-27House First Readers (House)
3. 2025-01-17House Hopper (House)

• Demetrius Douglas (D, HD-078)Primary sponsor
• Lee Hawkins (R, HD-027)
• Michelle Au (D, HD-050)
• Brian Prince (D, HD-132)
• Karen Bennett (D, HD-094)
• Jasmine Clark (D, HD-108)

• prescription drug costs
• health insurance
• drug rebates
• consumer protection
• insurance regulation