HB1119: HB1119 Labor and industrial relations; pharmacy care guidelines and pharmacy management networks under workers' compensation; provide

26 LC 52 0938 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 to1 workers' compensation, so as to provide for pharmacy care guide lines and pharmacy2 management networks under workers' compensation; to provide lim itations for providers3 prescribing certain medications; to provide for limitations for providers dispensing certain4 medications; to provide for reimbursement; to provide for pharmacy management networks;5 to provide for notice; to provide for any willing dispensing pr ovider to join a network; to6 provide for registration; to provide for a registration fee; to provide for requirements; to7 provide for exemption; to provide for definitions; to provide f or rules and regulations; to8 provide for related matters; to provide for an effective date; to repeal conflicting laws; and9 for other purposes.10 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:11 SECTION 1.12 Chapter 9 of Title 34 of the Official Code of Georgia Annotated , relating to workers'13 compensation, is amended in Part 1 of Article 6, relating to me dical attention for payment14 of compensation, by adding new Code sections to read as follows:15 H. B. 1119 - 1 - 26 LC 52 0938 "34-9-201.1.16 (a) As used in this Code section, the term:17 (1) 'Compounded medication' means a custom made prescription d rug prepared by a18 pharmacist or dispensing provider by mixing or altering ingredi ents to fit a patient's19 unique needs.20 (2) 'Dispensing provider' means an individual who is a licensed pharmacist or licensed21 physician.22 (3) 'Off-label medication' means a prescription drug used for a condition, age group,23 dosage, or route not listed in its official label.24 (4) 'Pharmacy care' means those services related to the interp retation, evaluation, or25 dispensing of prescription drug orders; the participation in dr ug and device selection,26 drug administration, and drug regimen reviews; and the provisio n of related patient27 counseling.28 (5) 'Pharmacy management network' means a group or groups of participating dispensing29 providers contracted by an employer to provide pharmacy care to injured workers30 receiving benefits under workers' compensation.31 (b) An employer may provide pharmacy care to injured employees receiving benefits32 under workers' compensation through a pharmacy management network or through such33 employee's choice of pharmacy or dispensing provider.34 (c) Any prescribing provider providing pharmacy care to an inj ured employee applying35 for or receiving benefits under workers' compensation shall pre scribe medications in36 accordance with the provisions of this chapter and board rules. Such provider shall:37 (1) Document medical necessity, obtain prior authorization, and be limited to prescribing38 a 30 day supply for any off-label medication; and39 (2) Document consideration of commercially available drugs that are approved by the40 federal Food and Dug Administration and medical reasons for any compounded41 H. B. 1119 - 2 - 26 LC 52 0938 medication, obtain prior authorization for such medication, and be limited to prescribing42 a 90 day supply total to be provided in 30 day supply increments for such medication.43 (d) Any dispensing provider providing pharmacy care to an injured employee applying for44 or receiving workers' compensation benefits in the first seven days following the date of45 injury shall dispense medications in accordance with the provis ions of this chapter and46 board rules. Dispensing shall be limited to:47 (1) A single five-day supply for Schedule II and Schedule III drugs; and48 (2) A single 14 day supply for all other medications.49 (e) Reimbursement for a dispensing provider shall be in accordance with the fee schedule50 established by the board; provided, however, that dispensing providers contracted with a51 pharmacy management network shall not be subject to the limitat ions or reimbursement52 standards provided in this Code section and may dispense medica tions to injured53 employees based on the provisions in the pharmacy management network contract.54 (f) The board is authorized to promulgate rules necessary for the administration of this55 Code section.56 34-9-201.2.57 (a) As used in this Code section, the term:58 (1) 'Dispensing provider' shall have the same meaning as set f orth in Code59 Section 34-9-201.1.60 (2) 'Pharmacy care' shall have the same meaning as set forth in Code Section 34-9-201.1.61 (3) 'Pharmacy management network' shall have the same meaning as set forth in Code62 Section 34-9-201.1.63 (b) An employer may establish or contract with a pharmacy mana gement network to64 provide pharmacy care to injured employees receiving benefits u nder workers'65 compensation; provided, however, that, if such employer requires such care to be provided66 exclusively through such network, such employer shall provide notice as follows:67 H. B. 1119 - 3 - 26 LC 52 0938 (1) When the pharmacy management network is first established, the employer shall68 provide notice to all employees , either by posting in a promine nt location in the69 workplace or by providing in paper or electronic format, information about and processes70 for filling a prescription through such network; and71 (2) When a reported injury occurs, the employer shall provide notice to the employee,72 either by providing in paper or electronic format, information about the requirements to73 use such network and information on dispensing providers participating in such network.74 (c) If an employer complies with the provisions of subsection (b) of this Code section, any75 injured employee can obtain medications that are medically nece ssary, compliant with76 pharmacy care guidelines provided for in Code Section 34-9-201. 1, and related to a77 compensable claim from his or her choice of dispensing provider or a dispensing provider78 participating in the pharmacy management network; provided, how ever, that, if such79 medications are obtained from a dispensing provider that is not part of such network, they80 shall be reimbursed at the fee schedule amount established by t he board until such81 dispensing provider is provided notice by the employer or the p harmacy management82 network that:83 (1) The injured employee is required to obtain pharmacy care t hrough a dispensing84 provider participating in the pharmacy management network;85 (2) Future pharmacy care through such dispensing provider shall not be reimbursed; and86 (3) The dispensing provider is invited to join such network, provided that such network87 shall accept as part of the network any dispensing provider tha t is licensed, in good88 standing, and willing to contract with such network and abide by the contract terms with89 such network.90 (d) Any pharmacy management networks providing pharmacy care for injured employees91 pursuant to this Code section shall register with the board and pay a licensing fee in an92 amount established by the board sufficient to cover administration of the provisions of this93 Code section.94 H. B. 1119 - 4 - 26 LC 52 0938 (e) A pharmacy management network shall:95 (1) Provide a timely process for participating dispensing providers to dispute a denial or96 the amount of reimbursement of a pharmacy bill;97 (2) Reimburse participating dispensing providers promptly but may contract for98 reimbursement amounts different from the fee schedule amount established by the board;99 (3) Not charge participating dispensing providers any fees, direct or indirect, associated100 with dispensing, processing, or billing for a prescription drug dispensed to an injured101 employee or any fee related to the enrollment or annual reenrollment of a participating102 dispensing provider in such network;103 (4) Offer a mail order option for injured employees to obtain medications;104 (5) Perform any audits of dispensing providers in accordance with the audit provisions105 in Code Section 26-4-118, 'The Pharmacy Audit Bill of Rights'; and106 (6) Reimburse pharmacy processing agents or third-party billers accepting assignment107 of bills from participating dispensing providers at the contrac tual amount agreed upon108 with the assigning dispensing provider.109 (f) For claims that are controverted or being disputed for com pensability, any injured110 employee shall not be required to use a dispensing provider in the pharmacy management111 network until such time as compensability is established and notice of compensability is112 provided to such employee.113 (g) Registered pharmacy management networks providing pharmacy care under this Code114 section are exempt from the provisions of Article 2 of Chapter 23 of Title 33, relating to115 licensing of administrators, and the provisions of Chapter 64 o f Title 33, relating to the116 regulation and licensure of pharmacy benefit managers.117 (h) The board is authorized to promulgate rules necessary for the administration of this118 Code section."119 H. B. 1119 - 5 - 26 LC 52 0938 SECTION 2.120 This Act shall become effective on January 1, 2027.121 SECTION 3.122 All laws and parts of laws in conflict with this Act are repealed.123 H. B. 1119 - 6 -