HB 100: Prescription Drug Consumer Financial Protection Act; enact

House Bill 100

By: Representatives Douglas of the 78th, Hawkins of the 27th, Au of the 50th, Prince of the 132nd, Bennett of the 94th, and others

A BILL TO BE ENTITLED

AN ACT

To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to require all health insurers to pass along no less than 80 percent of all prescription drug rebates to enrollees that such insurer receives from third parties with regard to such enrollee's prescription drugs; to provide for definitions; to provide for related matters; to provide for a short title; to provide for legislative findings; to provide for an effective date and applicability; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

This Act shall be known and may be cited as the "Prescription Drug Consumer Financial Protection Act."

SECTION 2.

The General Assembly finds:

(1) The citizens of this state frequently rely on state-regulated commercial insurers to secure access to the prescription medicines needed to protect their health;

(2) Commercial insurance plans increasingly require enrollees to bear significant out-of-pocket costs for their prescription medicines;

(3) High out-of-pocket costs of prescription medicines impact the ability of enrollees to start new and necessary medicines and to stay adherent to their prescriptions;

(4) High or unpredictable cost sharing requirements are a main driver of unaffordable enrollee out-of-pocket costs;

(5) The burdens of high or unpredictable cost sharing requirements are borne disproportionately by enrollees with chronic or debilitating conditions;

(6) Pharmaceutical manufacturers may offer sizeable rebates, discounts, and price concessions in connection with the dispensing or administration of a therapy, but enrollees do not necessarily financially benefit from these amounts at the point of sale, and, instead, insurers or other intermediaries may retain the value of rebates, discounts, and price concessions;

(7) Restrictions are needed on the ability of insurers and their intermediaries to retain rebates, discounts, and price concessions that instead should be directly passed on to enrollees as cost savings;

(8) Enrollees need equitable and accessible health coverage that does not impose unfair cost sharing burdens upon them; and

(9) The legislature intends that enrollees receive the benefit of meaningful and durable cost savings from rebates and other price concessions that would otherwise accrue to insurers in connection with the dispensing or administration of a particular drug therapy.

SECTION 3.

Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, is amended by adding a new Code section to read as follows:

"33-24-59.34.

(a) As used in this Code section, the term:

(1) 'Cost sharing requirement' means a deductible, coinsurance, copayment, or any other amount or limitation imposed on an enrollee for a covered prescription drug under the enrollee's health benefit plan.

(2) 'Health benefit plan' means any hospital, health, or medical expense insurance policy; hospital or medical service contract; employee welfare benefit plan; contract or agreement with a health maintenance organization; subscriber contract or agreement; contract or agreement with a preferred provider organization; accident and sickness insurance benefit plan; state healthcare plan; or other insurance contract under any other name. Such term shall not include self-funded, employer sponsored health benefit plans subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq.

(3) 'Insurer' means an accident and sickness insurer, fraternal benefit society, hospital service corporation, medical service corporation, healthcare corporation, health maintenance organization, preferred provider organization, provider sponsored health care corporation, managed care entity, or any similar entity authorized to issue contracts under this title or to provide health benefit policies.

(4) 'Price protection rebate' means a negotiated price concession that accrues directly or indirectly to the insurer, or other party on behalf of the insurer, in the event of an increase in the wholesale acquisition cost of a drug above a specified threshold.

(5) 'Rebate' means:

(A) Negotiated price concessions, including, but not limited to, base price concessions whether described as a rebate or otherwise and reasonable estimates of any price protection rebates and performance based price concessions that may accrue directly or indirectly to the insurer during the coverage year from a manufacturer, dispensing pharmacy, or other party in connection with the dispensing or administration of a prescription drug; and

(B) Reasonable estimates of any negotiated price concessions, fees, and other administrative costs that are passed through, or are reasonably anticipated to be passed through, to the insurer and serve to reduce the insurer's costs for acquiring a prescription drug.

(6) 'State healthcare plan' means:

(A) The state employees' health insurance plan established pursuant to Article 1 of Chapter 18 of Title 45;

(B) The health insurance plan for public school teachers established pursuant to Subpart 2 of Part 6 of Article 17 of Chapter 2 of Title 20;

(C) The health insurance plan for public school employees established pursuant to Subpart 3 of Part 6 of Article 17 of Chapter 2 of Title 20; and

(D) The Regents Health Plan established pursuant to authority granted to the board pursuant to Code Sections 20-3-31, 20-3-51, and 31-2-4.

(b) An insurer shall calculate the cost sharing requirement of an enrollee for each prescription drug provided through a health benefit plan at the point of sale to the enrollee based on a price that is reduced by an amount equal to at least 80 percent of all rebates received or to be received by such insurer in connection with the dispensing or administration of the prescription drug and shall describe such calculation in such plans.

(c) Noncompliance with this Code section by an insurer may result in the imposition of penalties set forth in Code Section 33-2-24 or other state laws, including the imposition of civil penalties and the suspension or revocation of an insurer's license.

(d) Nothing in this Code section shall preclude an insurer from decreasing an enrollee's cost sharing requirement.

(e) Except as described in subsection (f) of this Code section, neither an insurer nor its agents shall publish or otherwise disclose information regarding the actual amount of rebates that an insurer receives on a product, manufacturer, or pharmacy-specific basis. Such information qualifies as a trade secret pursuant to Code Section 10-1-761 and shall not be a public record for purposes of Article 4 of Chapter 18 of Title 50 and shall not be disclosed directly or indirectly to any nongovernmental party.

(f) Notwithstanding subsection (e) of this Code section, an insurer may disclose the information described therein in accord with a department request, an appropriate court order, or to a third party that needs such information to perform healthcare or administrative services for such insurer. Any nongovernmental party receiving such information shall maintain the confidentiality of such information in accord with this Code section and other applicable law."

SECTION 4.

This Act shall become effective on January 1, 2026, and shall apply to all policies issued, delivered, issued for delivery, or renewed in this state on or after such date.

SECTION 5.

All laws and parts of laws in conflict with this Act are repealed.