Georgia CommonsHouse · Passed · 2025-2026 Regular Session
HB 196: State employees' health insurance plan; drugs dispensed for self-administration; provisions
Last action July 1, 2025 · Effective Date
House Bill 196 would require the state employees' health insurance plan, teacher health plans, and the university system's health plan to reimburse pharmacies for drugs using a transparent, index based pricing method plus a set dispensing fee, starting January 1, 2026.
The summaries below were written by an AI model (claude-sonnet-5) from the text of the bill and are not part of it. Quote the text, not the summary. The stored text is the Enrolled version, the latest the General Assembly's website lists.
In plain language
Right now Georgia's state health plans (covering state employees, public school teachers and employees, and University System of Georgia members and retirees) reimburse pharmacies for prescription drugs through arrangements that can lack clear pricing standards. This bill adds a new section to Georgia law setting a specific reimbursement formula: pharmacies must be paid based on the national average drug acquisition cost, or if that's unavailable, a discounted percentage of average wholesale price or wholesale acquisition cost, plus a professional dispensing fee of at least $10.50 for chain pharmacies and $11.50 for independent pharmacies. The bill defines key terms like insurer, pharmacy benefits manager, and independent pharmacy, and bars insurers from getting around these reimbursement rules, including by routing claims through prescription discount cards. It gives the Commissioner of Insurance enforcement authority under Georgia's pharmacy benefits manager law (O.C.G.A. Chapter 33-64). The new reimbursement rules take effect January 1, 2026.
What the bill does
- Sets a minimum pharmacy reimbursement formula for drugs dispensed for self-administration under Georgia's state health plans, based on the national average drug acquisition cost or a comparable benchmark price.
- Requires a professional dispensing fee on top of the drug cost, at least $10.50 for chain pharmacies and $11.50 for independent pharmacies.
- Prohibits insurers and pharmacy benefits managers from bypassing these reimbursement rules, including through prescription discount card programs.
- Gives the Commissioner of Insurance enforcement authority over these pharmacy reimbursement rules under Georgia's pharmacy benefits manager law.
- Defines which health plans count as a 'state health plan' covered by the new rules: state employees, public school teachers and employees, and University System of Georgia members and retirees.
- Sets the new reimbursement requirement to take effect January 1, 2026.
Who it affects
State employees, public school teachers and employees, and University System of Georgia members and retirees who get prescriptions through their state health plans; pharmacies, especially independent and chain pharmacies that dispense those drugs; insurers and pharmacy benefits managers that administer the plans; and the Commissioner of Insurance, who gains enforcement duties.
Why it matters
Pharmacies serving state employees, teachers, and university system members would get a guaranteed, formula based payment plus a dispensing fee instead of reimbursement rates set solely by insurers or pharmacy benefits managers, which could affect independent pharmacies' finances and how state health plans budget for prescription drug costs.
Key provisions
- Section 1 adds new Code Section 45-18-22, defining terms including independent pharmacy, insurer, national average drug acquisition cost, pharmacy, pharmacy benefits manager, and state health plan.
- Subsection (b) sets the reimbursement formula: national average drug acquisition cost (or a fallback wholesale price benchmark) plus a dispensing fee of at least $10.50 (chain) or $11.50 (independent), effective January 1, 2026.
- Subsection (b)(2) allows state health plans to authorize higher reimbursement than the required minimum, but not lower.
- Subsection (c) bars insurers from circumventing the reimbursement rules, specifically naming prescription drug discount cards or programs as a prohibited workaround.
- Subsection (d) grants the Commissioner of Insurance enforcement authority under Georgia's pharmacy benefits manager licensing law (Chapter 64 of Title 33), in addition to any authority under existing contracts or law.
- Section 2 repeals any conflicting laws.
From the bill
“an insurer shall reimburse a pharmacy for a drug dispensed to a covered person for self-administration in the state health plan”
“A professional dispensing fee that is not less than $10.50 for chain pharmacies and $11.50 for independent pharmacies.”
“An insurer shall not circumvent the requirements regarding pharmacy reimbursement in this Code section in any manner, including without limitation by adjudicating claims through a prescription drug discount card or program.”
Status timeline
- Effective Date
- Act 307
- House Date Signed by Governor (House)
- House Sent to Governor (House)
- House Agreed Senate Amend or Sub (House)
- Senate Passed/Adopted By Substitute (Senate)
- Senate Third Read (Senate)
- Senate Read Second Time (Senate)
Show full history (16 actions)
- Senate Committee Favorably Reported By Substitute (Senate)
- Senate Read and Referred (Senate)
- House Passed/Adopted By Substitute (House)
- House Third Readers (House)
- House Committee Favorably Reported By Substitute (House)
- House Second Readers (House)
- House First Readers (House)
- House Hopper (House)
Sponsors
- Trey Kelley (R, HD-16)
- Darlene Taylor (R, HD-173)
- Matt Hatchett (R, HD-155)
- Carolyn Hugley (D, HD-141)
- Rick Jasperse (R, HD-11)
- Matthew Gambill (R, HD-15)
- Matt Brass (R, SD-6)
Votes
- House voteFebruary 21, 2025
168 yea, 0 nay (4 not voting, 8 excused)
- Senate voteMarch 27, 2025
55 yea, 0 nay (1 not voting, 0 excused)
- House voteMarch 31, 2025
166 yea, 0 nay (5 not voting, 9 excused)
Topics
- prescription drug pricing
- state employee health insurance
- pharmacy reimbursement
- pharmacy benefits managers
- teacher health plans