---
title: HB 654. Insurance; prohibit insurers from conditioning the payment of any medical test or procedure or prescription drug benefit on prior authorization
collection: bills
id: 2025-2026/hb654
cite_as: HB 654, 2025-2026 Regular Session (Ga.)
canonical_url: https://georgiacommons.org/bills/2025-2026/hb654
md_url: https://georgiacommons.org/bills/2025-2026/hb654.md
text_url: https://georgiacommons.org/bills/2025-2026/hb654/text
source_url: https://www.legis.ga.gov/legislation/70853
date: 2025-02-28
status: introduced
corpus_version: bills-2026-09-12
license: Public record of the Georgia General Assembly, via LegiScan; see about.md
publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice.
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omitted: votes and history
omitted_chars: 129
omitted_url: https://georgiacommons.org/bills/2025-2026/hb654.md?full=1
bill_number: HB 654
session: 2025-2026 Regular Session
session_slug: 2025-2026
chamber: House
bill_type: bill
status_date: 2025-02-26
last_action: House Second Readers
sponsors:
- Lisa Campbell
- Michelle Au
- David Wilkerson
- Jasmine Clark
- Anne Westbrook
text_version: Introduced
has_text: true
legiscan_url: https://legiscan.com/GA/bill/HB654/2025
upstream_id: 1985970
summaries_model: claude-sonnet-5
topic_tags:
- health insurance
- prior authorization
- pharmacy benefit managers
- medical practice regulation
- state employee health plan
---
# HB 654. Insurance; prohibit insurers from conditioning the payment of any medical test or procedure or prescription drug benefit on prior authorization
## Text
House Bill 654
By: Representatives Campbell of the 35th, Au of the 50th, Wilkerson of the 38th, Clark of the
108th, and Westbrook of the 163rd
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,
relating to general provisions regarding insurance, so as to prohibit insurers or third-party
administrators from conditioning the payment of any medical test or procedure or
prescription drug benefit on prior authorization; to amend Chapter 64 of Title 33 of the
Official Code of Georgia Annotated, relating to regulation and licensure of pharmacy benefit
managers, so as to prohibit pharmacy benefit managers from conditioning the payment of any
benefit for a prescription drug on prior authorization; to amend Article 2 of Chapter 34 of
Title 43 of the Official Code of Georgia Annotated, relating to medical practice, so as to
provide that a physician shall not be required to obtain any prior authorization in their
exercise of patient healthcare; to amend Part 1 of Article 1 of Chapter 18 of Title 45 of the
Official Code of Georgia Annotated, relating to state employees' health insurance plan, so
as not to condition the payment of any medical test or procedure or prescription drug benefit
on prior authorization; to provide for definitions; to provide for related matters; 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.
Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
general provisions regarding insurance, 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 'health benefit plan' means any individual or
group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,
or renewed in this state which provides major medical benefits by a healthcare corporation,
health maintenance organization, preferred provider organization, accident and sickness
insurer, fraternal benefit society, hospital service corporation, medical service corporation,
or other insurer or similar entity.
(b) Notwithstanding any provision of law to the contrary, neither an insurer nor a
third-party administrator shall condition the payment of any benefit for a medical test or
procedure or for a prescription drug upon any preapproval, prior authorization, or
precertification of any kind by an insurer if such test, procedure, or prescription drug is
otherwise covered under the health benefit plan and such medical test, procedure, or
prescription drug has been prescribed by licensed healthcare provider."
SECTION 2.
Chapter 64 of Title 33 of the Official Code of Georgia Annotated, relating to regulation and
licensure of pharmacy benefit managers, is amended by adding a new Code section to read
as follows:
"33-64-14.
(a) As used in this Code section, the term 'health benefit plan' means any individual or
group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,
or renewed in this state which provides major medical benefits by a healthcare corporation,
health maintenance organization, preferred provider organization, accident and sickness
insurer, fraternal benefit society, hospital service corporation, medical service corporation,
or other insurer or similar entity.
(b) Notwithstanding any provision of law to the contrary, a pharmacy benefit manager
shall not condition the payment of any benefit for a prescription drug upon any
preapproval, prior authorization, or precertification of any kind by such pharmacy benefit
manager, insurer, or purchaser if such prescription drug is otherwise covered under the
health benefit plan and such drug has been prescribed by a licensed healthcare provider."
SECTION 3.
Article 2 of Chapter 34 of Title 43 of the Official Code of Georgia Annotated, relating to
medical practice, is amended by adding a new Code section to read as follows:
"43-34-49.
No physician shall be required to obtain preapproval, prior authorization, or precertification
from an insurer with regard to the healthcare of his or her patients."
SECTION 4.
Part 1 of Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated,
relating to state employees' health insurance plan, is amended by adding a new Code section
to read as follows:
"45-18-4.2.
(a) As used in this Code section, the term 'health benefit plan' means any individual or
group plan, policy, or contract for healthcare services issued, delivered, issued for delivery,
or renewed in this state which provides major medical benefits by a healthcare corporation,
health maintenance organization, preferred provider organization, accident and sickness
insurer, fraternal benefit society, hospital service corporation, medical service corporation,
or other insurer or similar entity.
(b) Notwithstanding any provision of law to the contrary, the health insurance plan
established pursuant to this article shall not condition the payment of any benefit for a
medical test or procedure or for a prescription drug upon any preapproval, prior
authorization, or precertification of any kind if such test, procedure, or prescription drug
is otherwise covered under such plan and is prescribed by a licensed healthcare provider."
SECTION 5.
This Act shall become effective upon its approval by the Governor or upon its becoming law
without such approval and shall apply to all health benefit plans issued, delivered, issued for
delivery, or renewed in this state on or after July 1, 2026.
SECTION 6.
All laws and parts of laws in conflict with this Act are repealed.
## Summaries written by Georgia Commons
The following was written by claude-sonnet-5 from the text above and is not part of the bill. Quote the text, not the summary.
A Georgia House bill would bar health insurers, pharmacy benefit managers, and the state employee health plan from requiring prior authorization before paying for a covered medical test, procedure, or prescription drug ordered by a licensed provider.
### Plain-language summary
Under current practice, insurers, pharmacy benefit managers, and the State Health Benefit Plan can require doctors to get advance approval, called prior authorization, before they will pay for certain tests, procedures, or prescription drugs. This bill would stop that practice for anything already covered under a patient's health plan and prescribed by a licensed healthcare provider.
The bill adds new sections to four different parts of Georgia law: general insurance rules, pharmacy benefit manager regulation, physician licensing law, and the law governing the State Health Benefit Plan for state employees. Each section says insurers, pharmacy benefit managers, or the state plan cannot condition payment on any preapproval, prior authorization, or precertification. It also says physicians cannot be required to get such approval for patient care. The changes would take effect when the Governor signs the bill or it becomes law without a signature, and would apply to health plans issued or renewed in Georgia on or after July 1, 2026.
### What it does
- Bars insurers and third-party administrators from requiring prior authorization before paying for a covered medical test, procedure, or prescription drug prescribed by a licensed provider.
- Bars pharmacy benefit managers from requiring prior authorization before paying for a covered prescription drug under the same conditions.
- States that no physician can be required to get preapproval, prior authorization, or precertification from an insurer regarding patient healthcare.
- Applies the same no-prior-authorization rule to the State Health Benefit Plan that covers Georgia state employees.
- Sets the change to apply to health benefit plans issued, delivered, or renewed in Georgia on or after July 1, 2026.
### Who it affects
Health insurers, third-party administrators, pharmacy benefit managers, physicians, and the State Health Benefit Plan that covers Georgia state employees and retirees. Patients with individual or group health coverage in Georgia would also be affected, since covered care could no longer be delayed by prior authorization.
### Why it matters
If enacted, Georgians with insurance could get covered tests, procedures, and prescription drugs paid for without waiting on insurer approval, as long as a licensed provider prescribed the care. This would change how quickly patients can access treatment and how insurers and pharmacy benefit managers process claims.
### Key provisions
- Section 1 adds O.C.G.A. § 33-24-59.34, prohibiting insurers and third-party administrators from conditioning payment for a covered medical test, procedure, or prescription drug on prior authorization.
- Section 2 adds O.C.G.A. § 33-64-14, applying the same prohibition to pharmacy benefit managers for prescription drug benefits.
- Section 3 adds O.C.G.A. § 43-34-49, stating no physician shall be required to obtain preapproval, prior authorization, or precertification from an insurer regarding patient care.
- Section 4 adds O.C.G.A. § 45-18-4.2, applying the same prohibition to the State Health Benefit Plan for state employees.
- Section 5 sets the effective date as approval by the Governor or becoming law without signature, applying to health plans issued or renewed on or after July 1, 2026.
- Section 6 repeals all conflicting laws.
## Status
- Status: Introduced (2025-02-26)
- Last action: House Second Readers (2025-02-28)
- Sponsors: Lisa Campbell, Michelle Au, David Wilkerson, Jasmine Clark, Anne Westbrook
- Official page: https://www.legis.ga.gov/legislation/70853
> The history, votes, and amendments (129 characters) are at https://georgiacommons.org/bills/2025-2026/hb654.md?full=1