House Bill 1119
By: Representatives Carpenter of the 4th, Bonner of the 73rd, Stephens of the 164th, Gullett
of the 19th, and Yearta of the 152nd
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 9 of Title 34 of the Official Code of Georgia Annotated, relating to
workers' compensation, so as to provide for pharmacy care guidelines and pharmacy
management networks under workers' compensation; to provide limitations for providers
prescribing certain medications; to provide for limitations for providers dispensing certain
medications; to provide for reimbursement; to provide for pharmacy management networks;
to provide for notice; to provide for any willing dispensing provider to join a network; to
provide for registration; to provide for a registration fee; to provide for requirements; to
provide for exemption; to provide for definitions; to provide for rules and regulations; to
provide for related matters; to provide for an effective date; to repeal conflicting laws; and
for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Chapter 9 of Title 34 of the Official Code of Georgia Annotated, relating to workers'
compensation, is amended in Part 1 of Article 6, relating to medical attention for payment
of compensation, by adding new Code sections to read as follows:
<ins>"34-9-201.1.
(a) As used in this Code section, the term:
(1) 'Compounded medication' means a custom made prescription drug prepared by a
pharmacist or dispensing provider by mixing or altering ingredients to fit a patient's
unique needs.
(2) 'Dispensing provider' means an individual who is a licensed pharmacist or licensed
physician.
(3) 'Off-label medication' means a prescription drug used for a condition, age group,
dosage, or route not listed in its official label.
(4) 'Pharmacy care' means those services related to the interpretation, evaluation, or
dispensing of prescription drug orders; the participation in drug and device selection,
drug administration, and drug regimen reviews; and the provision of related patient
counseling.
(5) 'Pharmacy management network' means a group or groups of participating dispensing
providers contracted by an employer to provide pharmacy care to injured workers
receiving benefits under workers' compensation.
(b) An employer may provide pharmacy care to injured employees receiving benefits
under workers' compensation through a pharmacy management network or through such
employee's choice of pharmacy or dispensing provider.
(c) Any prescribing provider providing pharmacy care to an injured employee applying
for or receiving benefits under workers' compensation shall prescribe medications in
accordance with the provisions of this chapter and board rules. Such provider shall:
(1) Document medical necessity, obtain prior authorization, and be limited to prescribing
a 30 day supply for any off-label medication; and
(2) Document consideration of commercially available drugs that are approved by the
federal Food and Dug Administration and medical reasons for any compounded
</ins>
<ins>medication, obtain prior authorization for such medication, and be limited to prescribing
a 90 day supply total to be provided in 30 day supply increments for such medication.
(d) Any dispensing provider providing pharmacy care to an injured employee applying for
or receiving workers' compensation benefits in the first seven days following the date of
injury shall dispense medications in accordance with the provisions of this chapter and
board rules. Dispensing shall be limited to:
(1) A single five-day supply for Schedule II and Schedule III drugs; and
(2) A single 14 day supply for all other medications.
(e) Reimbursement for a dispensing provider shall be in accordance with the fee schedule
established by the board; provided, however, that dispensing providers contracted with a
pharmacy management network shall not be subject to the limitations or reimbursement
standards provided in this Code section and may dispense medications to injured
employees based on the provisions in the pharmacy management network contract.
(f) The board is authorized to promulgate rules necessary for the administration of this
Code section.
34-9-201.2.
(a) As used in this Code section, the term:
(1) 'Dispensing provider' shall have the same meaning as set forth in Code
Section 34-9-201.1.
(2) 'Pharmacy care' shall have the same meaning as set forth in Code Section 34-9-201.1.
(3) 'Pharmacy management network' shall have the same meaning as set forth in Code
Section 34-9-201.1.
(b) An employer may establish or contract with a pharmacy management network to
provide pharmacy care to injured employees receiving benefits under workers'
compensation; provided, however, that, if such employer requires such care to be provided
exclusively through such network, such employer shall provide notice as follows:
</ins>
<ins>(1) When the pharmacy management network is first established, the employer shall
provide notice to all employees, either by posting in a prominent location in the
workplace or by providing in paper or electronic format, information about and processes
for filling a prescription through such network; and
(2) When a reported injury occurs, the employer shall provide notice to the employee,
either by providing in paper or electronic format, information about the requirements to
use such network and information on dispensing providers participating in such network.
(c) If an employer complies with the provisions of subsection (b) of this Code section, any
injured employee can obtain medications that are medically necessary, compliant with
pharmacy care guidelines provided for in Code Section 34-9-201.1, and related to a
compensable claim from his or her choice of dispensing provider or a dispensing provider
participating in the pharmacy management network; provided, however, that, if such
medications are obtained from a dispensing provider that is not part of such network, they
shall be reimbursed at the fee schedule amount established by the board until such
dispensing provider is provided notice by the employer or the pharmacy management
network that:
(1) The injured employee is required to obtain pharmacy care through a dispensing
provider participating in the pharmacy management network;
(2) Future pharmacy care through such dispensing provider shall not be reimbursed; and
(3) The dispensing provider is invited to join such network, provided that such network
shall accept as part of the network any dispensing provider that is licensed, in good
standing, and willing to contract with such network and abide by the contract terms with
such network.
(d) Any pharmacy management networks providing pharmacy care for injured employees
pursuant to this Code section shall register with the board and pay a licensing fee in an
amount established by the board sufficient to cover administration of the provisions of this
Code section.
</ins>
<ins>(e) A pharmacy management network shall:
(1) Provide a timely process for participating dispensing providers to dispute a denial or
the amount of reimbursement of a pharmacy bill;
(2) Reimburse participating dispensing providers promptly but may contract for
reimbursement amounts different from the fee schedule amount established by the board;
(3) Not charge participating dispensing providers any fees, direct or indirect, associated
with dispensing, processing, or billing for a prescription drug dispensed to an injured
employee or any fee related to the enrollment or annual reenrollment of a participating
dispensing provider in such network;
(4) Offer a mail order option for injured employees to obtain medications;
(5) Perform any audits of dispensing providers in accordance with the audit provisions
in Code Section 26-4-118, 'The Pharmacy Audit Bill of Rights'; and
(6) Reimburse pharmacy processing agents or third-party billers accepting assignment
of bills from participating dispensing providers at the contractual amount agreed upon
with the assigning dispensing provider.
(f) For claims that are controverted or being disputed for compensability, any injured
employee shall not be required to use a dispensing provider in the pharmacy management
network until such time as compensability is established and notice of compensability is
provided to such employee.
(g) Registered pharmacy management networks providing pharmacy care under this Code
section are exempt from the provisions of Article 2 of Chapter 23 of Title 33, relating to
licensing of administrators, and the provisions of Chapter 64 of Title 33, relating to the
regulation and licensure of pharmacy benefit managers.
(h) The board is authorized to promulgate rules necessary for the administration of this
Code section."
</ins>
SECTION 2.
This Act shall become effective on January 1, 2027.
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.