HB 654: Insurance; prohibit insurers from conditioning the payment of any medical test or procedure or prescription drug benefit on prior authorization

Right now, Georgia insurers, pharmacy benefit managers, and the state employees' health plan can require prior authorization, meaning a doctor must get advance approval before an insurer will pay for a test, procedure, or drug. This bill would end that practice for anything already covered by the plan and prescribed by a licensed healthcare provider. The bill adds new sections to four different parts of Georgia law (O.C.G.A. Title 33, Title 43, and Title 45) covering private insurers and third-party administrators, pharmacy benefit managers, physicians themselves, and the State Health Benefit Plan for state employees. It also says physicians cannot be required to get insurer preapproval when treating patients. The changes would take effect when the Governor signs the bill or it otherwise becomes law, and would apply to health plans issued or renewed in Georgia on or after July 1, 2026.

• Bars insurers and third-party administrators from requiring prior authorization for any covered medical test, procedure, or prescription drug prescribed by a licensed provider.
• Bars pharmacy benefit managers from conditioning payment for a covered prescription drug on prior authorization.
• States that physicians cannot be required to obtain preapproval, prior authorization, or precertification from an insurer regarding patient care.
• Applies the same ban on prior authorization to the state employees' health insurance plan run under O.C.G.A. Chapter 18 of Title 45.
• Sets the law to apply to health benefit plans issued, delivered, or renewed in Georgia on or after July 1, 2026.

Health insurers and third-party administrators, pharmacy benefit managers, physicians and other licensed healthcare providers, and the state employees' health insurance plan are all directly covered. Georgia patients with private insurance, prescription drug coverage, or state employee health benefits would also feel the change when seeking covered care.

If enacted, patients whose tests, procedures, or prescriptions are already covered would no longer face delays or denials tied to prior authorization, a process insurers currently use to review whether to pay for care before it happens. This could speed up access to prescribed treatment but also removes a tool insurers use to manage costs.

• Section 1 adds O.C.G.A. § 33-24-59.34, barring insurers and third-party administrators from conditioning payment on prior authorization for covered tests, procedures, or drugs prescribed by a licensed provider.
• Section 2 adds O.C.G.A. § 33-64-14, applying the same prohibition to pharmacy benefit managers for covered prescription drugs.
• Section 3 adds O.C.G.A. § 43-34-49, stating no physician shall be required to obtain preapproval or prior authorization from an insurer regarding patient healthcare.
• Section 4 adds O.C.G.A. § 45-18-4.2, applying the prohibition to the state employees' health insurance plan.
• Section 5 sets the effective date as approval by the Governor (or becoming law without approval), applying to health benefit plans issued or renewed on or after July 1, 2026.
• Section 6 repeals any conflicting laws.

1. 2025-02-28House Second Readers (Cámara de Representantes)
2. 2025-02-27House First Readers (Cámara de Representantes)
3. 2025-02-26House Hopper (Cámara de Representantes)

• Lisa Campbell (D, HD-035)Patrocinador principal
• Michelle Au (D, HD-050)
• David Wilkerson (D, HD-038)
• Jasmine Clark (D, HD-108)
• Anne Westbrook (D, HD-163)

• prior authorization
• health insurance
• pharmacy benefit managers
• state employee health plan
• medical practice regulation