HB 326: State Health Benefit Plan Nonopioid Coverage Parity Act; enact

Georgia's state health benefit plan currently can cover opioid pain medications more favorably than nonopioid alternatives, through higher copays, deductibles, or extra approval hurdles for the nonopioid option. This bill adds a new section to Georgia law (O.C.G.A. § 45-18-4.3) requiring the plan to cover 'qualifying nonopioid pain management drugs,' meaning FDA-approved nonopioid drugs for acute or postoperative pain that are on the Department of Community Health's approved list, under the same deductibles, coinsurance, copayments, exclusions, and other limits that apply to similar opioid drugs. The plan could still offer better coverage for nonopioid drugs than opioid drugs, just not worse. It could not require patients to try an opioid first (a practice called step therapy) before getting a covered nonopioid drug, and it could not require prior authorization for the nonopioid drug unless it requires the same for the opioid version. The law states legislative findings about the costs of the opioid epidemic and would take effect January 1, 2027.

• Adds a new Georgia law (O.C.G.A. § 45-18-4.3) requiring the state health benefit plan to cover qualifying nonopioid pain drugs on par with opioid pain drugs.
• Bars the plan from requiring patients try an opioid first (step therapy) before covering an approved nonopioid pain drug.
• Bars the plan from requiring prior authorization for nonopioid pain drugs unless it requires the same for comparable opioid drugs.
• Allows the plan to offer even better coverage for nonopioid drugs than for opioids, but not worse.
• Sets an effective date of January 1, 2027 for the new coverage requirements.

State employees, teachers, and other members enrolled in Georgia's state health benefit plan; the Department of Community Health, which selects qualifying drugs for its formulary; pharmacies and physicians who prescribe or dispense pain medications; and the plan administrators who set coverage rules.

Patients on the state health benefit plan facing acute or postoperative pain could get nonopioid medications without paying more out of pocket or clearing extra approval hurdles compared to opioids, potentially giving doctors and patients more freedom to choose nonopioid options first.

• Section 1 gives the bill its short title, the 'State Health Benefit Plan Nonopioid Coverage Parity Act.'
• Section 2 states legislative findings that the opioid epidemic has cost Georgia money and that nonopioid coverage parity could reduce those costs.
• Section 3 adds O.C.G.A. § 45-18-4.3, defining 'qualifying nonopioid pain management drugs' as FDA-approved, non-opioid-receptor, non-Schedule I or II drugs chosen by the Department of Community Health for its formulary.
• Section 3(b) requires the same deductibles, coinsurance, copayments, exclusions, and utilization review for qualifying nonopioid drugs as for comparable opioid drugs.
• Section 3(d) bans step therapy requiring opioid use before nonopioid coverage and limits prior authorization requirements to match those for opioids.
• Section 3(e) clarifies the law does not restrict a healthcare provider's ability to prescribe medically appropriate treatment.
• Section 4 sets the effective date as January 1, 2027.

1. 2026-02-24House Committee Favorably Reported By Substitute (Cámara de Representantes)
2. 2025-02-11House Second Readers (Cámara de Representantes)
3. 2025-02-10House First Readers (Cámara de Representantes)
4. 2025-02-06House Hopper (Cámara de Representantes)

• Michelle Au (D, HD-050)Patrocinador principal
• Ron Stephens (R, HD-164)
• Sharon Cooper (R, HD-045)
• Mary Oliver (D, HD-084)
• Lee Hawkins (R, HD-027)

• state health benefit plan
• opioid epidemic
• prescription drug coverage
• health insurance for state employees