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Official Code of Georgia Annotated

Title 33. INSURANCE · Chapter 64. REGULATION AND LICENSURE OF PHARMACY BENEFITS MANAGERS

33-64-4. Pharmacy benefits manager shall not engage in the practice of medicine; recommended use of licensed physician.

Active

Current through: Including Acts of the 2025 Regular Session of the General Assembly.

For effective date, see note.In force today: For effective date, see note.
  1. (a)

    No pharmacy benefits manager shall engage in the practice of medicine, except as otherwise provided in subsection (b) of this Code section.#

  2. (b)

    Any physician employed by or contracted with a pharmacy benefits manager advising on or making determinations specific to a Georgia insured in connection with a prior authorization or step therapy appeal or determination review shall:#

    1. (1)

      Have actively seen patients within the past five years; and#

    2. (2)

      Have practiced in the same specialty area for which he or she is providing advisement within the past five years.#

  3. (c)

    For contracts and amendments entered into with a pharmacy benefits manager on and after July 1, 2021, the department is encouraged to require the use of a licensed Georgia physician for prior authorization or step therapy appeal or determination reviews.#

The notes below are printed with the section but are not enacted law (O.C.G.A. § 1-1-1(c)). They are shown apart from the text.

History

Code 1981, § 33-64-4, enacted by Ga. L. 2010, p. 757, § 1/SB 310; Ga. L. 2020, p. 768, § 3/HB 946; Ga. L. 2020, p. 780, § 3/SB 313.

Delayed effective date

This Code section, as set out above, becomes effective July 1, 2021. For version of this Code section in effect until July 1, 2021, see the 2020 amendment note.

Editor's notes

Ga. L. 2020, p. 768, § 9(a)/HB 946 and Ga. L. 2020, p. 780, § 9(a)/SB 313, not codified by the General Assembly, provide, in part, that the amendment by that Act shall apply to all contracts issued, delivered, or issued for delivery in this state on and after July 1, 2021.

Code Commission notes

Pursuant to Code Section 28-9-5, in 2020, ‘‘July 1, 2021’’ was substituted for ‘‘the effective date of this Act’’ in the middle of subsection (c).

Other notes

The 2020 amendments.
The first 2020 amendment, effective July 1, 2021, designated the existing provisions as subsection (a); added ‘‘, except as otherwise provided in subsection (b) of this Code section’’ at the end of subsection (a); and added subsections (b) and (c). The second 2020 amendment, effective July 1, 2021, made identical changes. See the Editor’s notes for applicability.

Read the official page (the state's PDF, opened at the page this text was read from).

Current through: Including Acts of the 2025 Regular Session of the General Assembly.

Text read from t33-ch23-65-(v25)-2020-pdf.pdf, Volume V25, 2020 edition, page 1096; merge action: carried; file SHA-256 1cdfeaa4b73e.