26-4-119. Pharmacy anti-steering and transparency; prohibited activities.

1. (a)

   This Code section shall be known and may be cited as the “Pharmacy Anti-Steering and Transparency Act.”#

2. (b)

   The General Assembly finds that:#

   1. (1)

      The referral of a patient to a pharmacy by an affiliate for pharmacy care represents a potential conflict of interest; and#

   2. (2)

      These referral practices may limit or eliminate competitive alternatives in the health care services market, may result in overutilization of health care services, may increase costs to the health care system, may adversely affect the quality of health care, may disproportionately harm patients in rural and medically underserved areas of Georgia, and shall be against the public policy of this state.#

3. (c)

   As used in this Code section, the term:#

   1. (1)

      “Affiliate” means a person licensed under Title 33 which, either directly or indirectly through one or more intermediaries:#

      1. (A)

         Has an investment or ownership interest in a pharmacy licensed in or holding a nonresident pharmacy permit in Georgia;#

      2. (B)

         Shares common ownership with a pharmacy licensed in or holding a nonresident pharmacy permit in Georgia; or#

      3. (C)

         Has as an investor or ownership interest holder a pharmacy licensed in or holding a nonresident pharmacy permit in Georgia.#

   2. (2)

      “Referral” means:#

      1. (A)

         Ordering of a patient to a pharmacy by an affiliate either orally or in writing, including online messaging;#

      2. (B)

         Ordering of a patient to a pharmacy that has an affiliate either orally or in writing, including online messaging by a person licensed under Title 33 as a result of an arrangement or agreement between the person and the pharmacy’s affiliate;#

      3. (C)

         Offering or implementing plan designs that require patients to utilize affiliated pharmacies or other pharmacies with affiliates, or that increase plan or patient costs, including requiring patients to pay the full cost for a prescription when patients choose not to use affiliated pharmacies or other pharmacies with affiliates; or#

      4. (D)

         Patient or prospective patient specific advertising, marketing, or promotion of a pharmacy by an affiliate or other person licensed under Title 33 as a result of an arrangement or agreement with the pharmacy’s affiliate.#

      5. Subject to the foregoing, this term shall not include a pharmacy’s inclusion by an affiliate or other person licensed under Title 33 as a result of an arrangement or agreement with the pharmacy’s affiliate in communications to patients, including patient and prospective patient specific communications, regarding network pharmacies and prices, provided that the affiliate or other person licensed under Title 33 includes information regarding eligible nonaffiliate pharmacies in such communications and the information provided is accurate.

4. (d)

   A pharmacy licensed in or holding a nonresident pharmacy permit in Georgia shall be proscribed from:#

   1. (1)

      Transferring or sharing records relative to prescription information containing patient identifiable and prescriber identifiable data to or from an affiliate for any commercial purpose; provided, however, that nothing shall be construed to prohibit the exchange of prescription information between a pharmacy and its affiliate for the limited purposes of pharmacy reimbursement; formulary compliance; pharmacy care; public health activities otherwise authorized by law; or utilization review by a health care provider; or#

   2. (2)

      Presenting a claim for payment to any individual, third-party payor, affiliate, or other entity for a service furnished pursuant to a referral from an affiliate or other person licensed under Title 33.#

5. (e)

   This Code section shall not be construed to prohibit a pharmacy from entering into an agreement with an affiliate to provide pharmacy care to patients, provided that the pharmacy does not receive referrals in violation of subsection (d) of this Code section and the pharmacy provides the disclosures required in subsection (f) of this Code section.#

6. (f)

   If a pharmacy licensed or holding a nonresident pharmacy permit in this state has an affiliate, it shall annually file with the board a disclosure statement identifying all such affiliates.#

7. (g)

   In addition to any other remedy provided by law, a violation of this Code section by a pharmacy shall be grounds for disciplinary action by the board pursuant to its authority granted in this chapter.#

8. (h)

   A pharmacist who fills a prescription that violates subsection (d) of this Code section shall not be liable under this Code section.#

9. (i)

   This Code section shall not apply to:#

   1. (1)

      Any licensed group model health maintenance organization with an exclusive medical group contract which operates its own pharmacies which are licensed under Code Section 26-4-110;#

   2. (2)

      Any hospital or related institution; or#

   3. (3)

      Any referrals by an affiliate for pharmacy services and prescriptions to patients in skilled nursing facilities, intermediate care facilities, continuing care retirement communities, home health agencies, or hospices.#

Reading note: a word broken across two lines in the printed volume was joined by rule and could not be checked against the volume's own vocabulary. The official page linked below settles any doubt.