2020 Legislative Update: Week 2
With all five days in session, legislative days 5-9 went by quickly. While there were not many bills introduced that impact pharmacy, as more fully elaborated below, week 2 proved to be a week of significance and consequence with one of the most sweeping PBMs bills ever introduced in the nation being dropped by Senator Dean Burke.
SB 313: PBM Regulation
Introduced by Senator Dean Burke, a physician from Bainbridge, SB 313 is a sweeping piece of PBM legislation that looks to, amongst other things:
- Do a much-needed update to existing provisions including definitions;
- Increase the commissioner of insurance’s authority and ability to audit and investigate PBM practices, and to fine for violations;
- Remove exemptions for Medicaid managed care;
- Replace the existing MAC pricing law and replace it with a requirement to base reimbursements off NADAC, a transparent federal public benchmark that prices drugs, and Georgia’s Select Specialty Pharmacy Rate for specialty drugs;
- Contemplate a reimbursement appeals process;
- Prohibit PBMs from tying the reimbursement of a drug to patient outcomes;
- Prohibit deriving revenue from patients and network pharmacies including retroactive recoupments;
- Act as a fiduciary to plans including passing along rebates;
- Prohibit spread pricing;
- Prohibit copay accumulator practices;
- Prohibit removing coverage for a drug for the purpose of incentivizing a patient to seek coverage from a different plan;
- Prohibit withholding coverage or requiring a prior authorization for a generic;
- Strengthen anti-steering provisions passed into law last year; and
- Impose a first-in-the-nation morals clause on PBMs that contract with the state — it would require them to abide by Georgia law for all services performed on Georgia claims.
Finally, to the extent PBMs continue to engage in practices of steering and imposing retroactive fees, this legislation will seek to implement a 10 percent surcharge on PBMs and their insurer clients on all claims administered in the state of Georgia. While never applied to PBMs in the country before, this provision sends a message that even if PBMs find a way around existing law, they are going to pay for it.
As powerful as this bill is, the support of senate leadership is equally powerful. With Senator Burke as the sponsor, the top cosponsors include Senator Ben Watson (chair of Senate Health and Human Services), Senator Mike Dugan (majority leader), Senator John Kennedy (majority caucus chairman), and Senator Chuck Hufstetler (chair of Senate Finance).
Please take the time to reach out and thank Senator Burke and the other cosponsors for their tremendous support and leadership. Clicking their names will bring you to their individual Web pages, which should include contact forms.
Upcoming Pharmacists at the Capitol events
There will be more to come on GPhA’s Pharmacists at the Capitol events once additional pharmacy legislation is introduced in the House.
