---
title: HB 810. Insurance; require that final reimbursements to pharmacies for prescription drugs are based on certain formulas
collection: bills
id: 2025-2026/hb810
cite_as: HB 810, 2025-2026 Regular Session (Ga.)
canonical_url: https://georgiacommons.org/bills/2025-2026/hb810
md_url: https://georgiacommons.org/bills/2025-2026/hb810.md
text_url: https://georgiacommons.org/bills/2025-2026/hb810/text
source_url: https://www.legis.ga.gov/legislation/71509
date: 2026-03-06
status: introduced
corpus_version: bills-2026-09-13
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: 439
omitted_url: https://georgiacommons.org/bills/2025-2026/hb810.md?full=1
bill_number: HB 810
session: 2025-2026 Regular Session
session_slug: 2025-2026
chamber: House
bill_type: bill
status_date: 2025-03-20
last_action: House Committee Favorably Reported By Substitute
sponsors:
- Rick Jasperse
- Lee Hawkins
- Darlene Taylor
- Ron Stephens
- Mark Newton
- Michelle Au
text_version: Comm Sub
has_text: true
legiscan_url: https://legiscan.com/GA/bill/HB810/2025
upstream_id: 2012187
summaries_model: claude-sonnet-5
topic_tags:
- pharmacy reimbursement
- pharmacy benefits managers
- prescription drug costs
- rural pharmacies
- insurance regulation
---
# HB 810. Insurance; require that final reimbursements to pharmacies for prescription drugs are based on certain formulas
## Text
The House Committee on Health offers the following substitute to HB 810:
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 64 of Title 33 of the Official Code of Georgia Annotated, relating to
regulation and licensure of pharmacy benefits managers, so as to require that final
reimbursements to eligible pharmacies for prescription drugs are based on certain formulas;
to provide for applicability; to provide for definitions; to provide for construction; 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.
Chapter 64 of Title 33 of the Official Code of Georgia Annotated, relating to regulation and
licensure of pharmacy benefits managers, is amended by adding a new Code section to read
as follows:
"33-64-9.2.
(a) As used in this Code section:
(1) 'Affiliate pharmacy' means a pharmacy which, either directly or indirectly through
one or more intermediaries:
(A) Has an investment or ownership interest in a pharmacy benefits manager licensed
under this chapter;
(B) Shares common ownership with a pharmacy benefits manager licensed under this
chapter; or
(C) Has an investor or ownership interest holder which is a pharmacy benefits manager
licensed under this chapter.
(2) 'Eligible pharmacy' means a pharmacy which is not owned by an entity or natural
person that has an investor or ownership interests in more than ten pharmacies.
(3) 'Rural area' means any county having a population of less than 50,000 according to
the United States decennial census of 2020 or any future such census.
(4) 'Rural pharmacy' means any eligible pharmacy located in a rural area.
(b) A pharmacy benefits manager shall ensure that the final reimbursement, after taking
into account any and all fees, charges, adjustments, or other reductions, including, but not
limited to, direct or indirect renumeration fees, administrative fees, performance based fees,
network access fees, or any other fees or adjustments, or other similar constructs, to an
eligible pharmacy for a prescription drug is in an amount equal to the national average drug
acquisition cost for the prescription drug at the time that such drug was dispensed, plus a
professional dispensing fee in an amount equal to the current Georgia Medicaid
professional dispensing fee as determined by the Department of Community Health. If the
national average drug acquisition cost at the time such drug was dispensed is not available,
a pharmacy benefits manager shall reimburse an eligible pharmacy in an amount equal to
the wholesale acquisition cost of the drug, as defined in 42 U.S.C.
Section 1395w-3a(c)(6)(B), on January 1, 2026, plus a professional dispensing fee in an
amount equal to the current Georgia Medicaid professional dispensing fee as determined
by the Department of Community Health. A pharmacy benefits manager shall exclude any
reimbursement made pursuant to this subsection from any effective rate guarantees. As
used in this subsection, the term 'effective rate guarantees' means a contractual provision
whereby a pharmacy benefits manager may adjust reimbursement rates to eligible
pharmacies for prescription drugs dispensed by any such pharmacy during a certain period
of time, ensuring that the pharmacy's overall reimbursement averages out to be a
predetermined rate.
(c) This Code section shall not apply to a state health plan, as such term is defined in Code
Section 45-18-22. This Code section shall also not apply to Medicaid under Chapter 4 of
Title 49, including Medicaid managed care programs administered through care
management organizations.
(d) Notwithstanding any other provision of this Code section, nothing herein shall be
construed to prohibit or restrict a pharmacy benefits manager from providing
reimbursement to a rural pharmacy in an amount exceeding the national average drug
acquisition cost for a prescription drug plus the professional dispensing fee otherwise
required under this Code section; provided, however, that this exception shall not apply to
affiliate, mail-order, and specialty pharmacies."
SECTION 2.
This Act shall become effective July 1, 2027.
SECTION 3.
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.
HB810 would require pharmacy benefits managers in Georgia to pay independent pharmacies a set reimbursement formula for prescription drugs, based on national average drug costs plus a dispensing fee, starting July 1, 2027.
### Plain-language summary
Pharmacy benefits managers (companies that process prescription drug claims for insurers) currently negotiate reimbursement rates with pharmacies, and critics say those rates can be unpredictable or squeeze independent drugstores. HB810 adds a new section to Georgia's pharmacy benefits manager law setting a required formula for what counts as 'eligible pharmacies,' generally those not owned by a company with stakes in more than ten pharmacies.
Under the bill, a pharmacy benefits manager must pay an eligible pharmacy the national average drug acquisition cost for a drug, plus a dispensing fee matching the current Georgia Medicaid rate. If that national cost figure is unavailable, the manager must use the wholesale acquisition cost as of January 1, 2026, plus the same dispensing fee. The law would not apply to the State Health Benefit Plan or to Medicaid programs. Pharmacies in rural counties (under 50,000 people) could still be paid more than the formula amount, except for affiliate, mail-order, or specialty pharmacies. The law would take effect July 1, 2027.
### What it does
- Creates a new Georgia law (O.C.G.A. Section 33-64-9.2) setting a mandatory reimbursement formula pharmacy benefits managers must use for eligible pharmacies.
- Defines 'eligible pharmacy' to exclude pharmacies owned by entities with stakes in more than ten pharmacies, and defines 'affiliate pharmacy' as one connected to a pharmacy benefits manager.
- Requires reimbursement equal to the national average drug acquisition cost plus a dispensing fee matching Georgia's Medicaid dispensing fee rate.
- Bars pharmacy benefits managers from folding these required payments into 'effective rate guarantees' that average reimbursements over time.
- Exempts the State Health Benefit Plan and Medicaid programs from the new reimbursement rules.
- Allows higher payments to rural pharmacies but excludes affiliate, mail-order, and specialty pharmacies from that rural exception.
### Who it affects
Independent and small-chain pharmacies across Georgia, especially those in rural counties with fewer than 50,000 residents, as well as pharmacy benefits managers that process prescription drug claims for private insurance plans. State Medicaid programs and the State Health Benefit Plan are explicitly excluded.
### Why it matters
Eligible pharmacies would gain a guaranteed minimum payment formula rather than relying on negotiated or fluctuating rates set by pharmacy benefits managers, which could affect their financial stability. Rural pharmacies could still negotiate higher payments, potentially helping keep drugstores open in smaller communities.
### Key provisions
- Section 1 adds new Code Section 33-64-9.2 defining 'eligible pharmacy,' 'affiliate pharmacy,' 'rural area,' and 'rural pharmacy' for purposes of the reimbursement rule.
- Subsection (b) sets the reimbursement formula: national average drug acquisition cost plus a Georgia Medicaid-matching dispensing fee, with a fallback to wholesale acquisition cost as of January 1, 2026 if the national figure is unavailable.
- Subsection (b) also bars pharmacy benefits managers from applying 'effective rate guarantees' that average out reimbursements over time to these required payments.
- Subsection (c) exempts the State Health Benefit Plan and Medicaid, including Medicaid managed care organizations, from the new rule.
- Subsection (d) permits higher payments to rural pharmacies but excludes affiliate, mail-order, and specialty pharmacies from that exception.
- Section 2 sets the effective date as July 1, 2027.
## Status
- Status: Introduced (2025-03-20)
- Last action: House Committee Favorably Reported By Substitute (2026-03-06)
- Sponsors: Rick Jasperse, Lee Hawkins, Darlene Taylor, Ron Stephens, Mark Newton, Michelle Au
- Official page: https://www.legis.ga.gov/legislation/71509
> The history, votes, and amendments (439 characters) are at https://georgiacommons.org/bills/2025-2026/hb810.md?full=1