2021 Legislative Update: Week 4

Week 4 (legislative days 9-12) of Georgia’s legislation session included GPhA engaging in substantive discussions on legislation already introduced as well as legislation expected to be introduced. While SB 46 (pharmacist vaccine expansion) has not yet been heard in committee, we anticipate that it will be heard in week 5. 

Week 4 also saw the introduction of several pieces of legislation which GPhA will be monitoring and likely engaging in. 

Finally, week 4 saw GPhA’s first virtual Day at the Dome event which was held via Zoom with students from Mercer and PCOM learning about the importance of engaging in the legislative process from Representatives Ron Stephens and David Knight, as well as GPhA President Wes Chapman.  In addition, students were provided with an update on the history of pharmacist administration of vaccines via protocol agreements from GPhA past president Dr. Liza Chapman.  A special thank you to all of them as well as Dr. Jonathon Hamrick for his efforts in coordinating and planning this event. 

Legislation Introduced in Week 4

HB 213

Representative Robichaux introduced several pieces of health care legislation in week 4, including HB 213 which looks to looks to provide full practice authority for APRNs, including the authority to order, prescribe, procure, administer, dispense, or furnish prescription drugs including controlled substances. 

HB 217

Also introduced by Representative Robichaux, this bill looks to require quality and payment reporting for health plans administered by the Department of Community Health. Reporting is to include data on the state health benefit plan, the plan for public school teachers, and Medicaid.  This legislation also requires comprehensive dental and vision coverage for Medicaid. 

SB 80

This bill, introduced by Senator Kirkpatrick, creates the Ensuring Transparency in Prior Authorization Act. It is important to note at the outset that while this bill deals with certain issues in connection prior authorizations for prescription drugs it is broader than that, also dealing with prior authorization for medical procedures. 

The bill applies to health insurers as well as PBMs and deals primarily with adverse determinations by utilization review entities on the grounds that a healthcare service is not medically necessary or is experimental or investigational and thus denied.  It does not appear to include negative coverage determinations based on non-medical grounds. 

Amongst other things, this bill requires:

• Utilization review entities to make prior authorization requirements and restrictions available to enrollees, providers, and the general public on a website.
• Utilization review entities to provide 60 days written notice of changes to prior authorization requirements and restrictions.
• Utilization review entities to provide statistics of rates of approval and denial on their website.
• Physicians advising or making decisions for utilization review committees meet certain requirements.
• Prior authorizations for urgent healthcare services be completed within 24 hours of receiving all information necessary to make the determination.
• Requires coverage for emergency services necessary to screen and stabilize a patient.

In addition, the bill provides that a prior authorization of a covered service shall be a guarantee of payment to the provider unless there is a billing error, fraud, or material misrepresentation. 

Regarding prescription drugs in particular, this bill provides that a prior authorization given is good for a year, subject to certain exceptions, even if there are dosage changes.  

Also, by January of 2022, pharmacy benefits prior authorization requests shall be accepted by payors through the National Council for Prescription Drug Program’s SCRIPT Standard ePA transactions, Version 2013101, in effect on the effective date of the law. It further provides that faxes, and other technology not directly integrated with a physician’s electronic health record or electronic prescribing system, shall not be considered a secure electronic transmission for purposes of prior authorizations.

2021 Legislative Update: Week 3

As is typical, legislative days 5 through 7 saw a significant uptick of bills being filed, with several of them dealing with healthcare. This year, GPhA’s legislative priority is expanding the ability of pharmacists to administer vaccines from four (pneumococcal, influenza, meningitis, and shingles) to include all ACIP recommended vaccines for adults. We are excited to report that a bill was introduced that seeks to do just that.

More specifically, Dr. Burke, Chairman of the Senate Insurance and Labor Committee introduced SB 46, which proposes to expand pharmacist and nurse administered vaccines pursuant to a physician protocol agreement to include all ACIP vaccines for adults as well as well as any vaccine for an illness that has resulted in a public health emergency. In addition, it imposes on pharmacists and nurses the requirement to check GRITS prior to administering a vaccine.

This legislation was born out of the state’s recognition of the central role pharmacists have played in combating COVID-19 including their role in administering the COVID-19 vaccine. The Georgia Department of Public Health has spent significant time in working on this legislation and has made it a priority for the state.  The Medical Association of Georgia is also in support of this legislation as are other key stakeholders. GPhA will continue to focus much of its energy to supporting this legislation as it makes its way through the General Assembly.  

There were also several other pieces of legislation introduced that GPhA is watching. 

Legislation

HB 49

Representative Hutchinson’s Mental Health Parity Act seeks to improve insurance coverage for the treatment of mental health conditions, including requiring healthcare plans that provide coverage for prescription drugs, not to exclude coverage for any FDA approved medications prescribed for the treatment of any category of mental disorder or substance use disorder.  It also requires healthcare plans to include all prescription medications approved by the FDA for the treatment of mental disorders or substance use disorders on the lowest tier of the drug formulary developed and maintained by the plan. 

HB 93

Introduced by Representative Cooper, this bill looks to eliminate duplicative state licensure and regulation of clinical laboratories by removing much of the Georgia clinical lab code and instead requiring that any clinical lab operating in Georgia be certified by the federal Centers for Medicare and Medicaid Centers, pursuant to the federal Clinical Laboratory Improvement Amendments of 1988.  While such a change is likely a good thing, there do appear to be some implications for pharmacy testing which GPhA is looking at closely.  More to come.  

HB 112

This bill, introduced by Representative Kelley, looks to extend COVID-19 immunity protections for businesses and healthcare providers put into law last year from July 2021 to July 2022.

HB 117

Representative Wilensky’s bill seeks to add ulcerative colitis as an approved condition for which a patient is eligible to receive Low-THC oil.  

HB 164

Titled the Prescription Drug Consumer Financial Protection Act, Representative Douglas’ legislation looks to require insurers to calculate an enrollees cost-sharing requirements for a prescription drug at the point of sale, based on a price that is reduced by an amount equal to at least 80% of all rebates received or to be received by such insurer.

2021 Legislative Session: Week 1

Week 1 Update: Legislative days 1 – 4

Georgia’s 2021 legislative session convened on Monday, January 11, and, as always, GPhA was there. With COVID-19 still raging, safety protocols at the Capitol include mask wearing, no access to third floor rope lines, and office visits with legislators by appointment. There is also a testing station where legislators and legislative staff can be tested and several legislators did test positive for COVID-19.

Hot off the contentious presidential election and Georgia U.S. Senate runoffs, security was tight and there is expected to be attention paid to Georgia’s elections process. In addition, while Georgia’s economy is looking much stronger than many states, the state budget will also garner significant attention.

On the pharmacy front, week one was a relatively quiet one in terms of bills being introduced, but it proved busy behind the scenes reviewing draft legislation which may impact pharmacy and engaging in stake holder discussions. Many of those discussions focused on the role pharmacists have played in combatting COVID-19 including their role in authorizing and administering the COVID-19 vaccine in Phase 1A. Pharmacists have been able to do this pursuant to U.S. HHS authorization under the PREP Act as well as Governor Kemp’s Executive Order as current Georgia law does not contemplate this authority for pharmacists.

GPhA is working with the state and other stakeholders to change Georgia law to allow pharmacists to continue to administer the COVID-19 vaccine after the period of emergency as well as expanding vaccines pharmacists can administer via protocol to include all ACIP recommended vaccines for adults.

Week 1 Legislation

HB 73

Introduced by Rep. Hugley, this legislation proposes to limit copays for insulin in the commercial and Medicaid managed care space to no more than $50 per thirty-day supply. In addition, it requires insurers and Medicaid CMOs to file an annual report to the state identifying the twenty five most expensive drugs on the plan, and the frequency of provision of those drugs.

Next update

With no legislative days the week of January 18 (House will be focusing on appropriations subcommittee meetings), the week 2 legislative update will be provided on February 1.

2020 Legislative Session Wrap-up

Greg Reybold, General Counsel & VP of Public Policy, Georgia Pharmacy Association

Georgia’s 2020 session was, to put it mildly, a unique one.  To begin with, GPhA’s initiatives were far reaching, and, following the success of 2019, fiercely contested by lobbyists for PBMs, insurance companies, as well as Medicaid care management organizations.  

That combined with legislative session being suspended for well over two months following cross-over day, the budget needing to be approved with significant cuts, and a limited number of bills being taken up by the general assembly for the final 11 days of legislative session, made for head winds the likes of which we have never seen.  

Nonetheless, GPhA, and its members, remained focused on its legislative initiatives.  That focus resulted in, despite the adversity, one of GPhA’s most successful legislative sessions in history with the passage of four pieces of priority legislation as well as the engagement of an important study.

These bills now go to the Governor, with the hopes that they receive his favorable consideration and are signed into law.  

As you read through the details of GPhA priority legislation please keep in mind that GPhA members were an integral part of the successes of this landmark legislative session. Time and again you answered the call.  You were, however, not alone.  Please join us in extending appreciation to the National MS Society and their Senior Manager of Advocacy, Heather Breeden; the Rx in Reach Coalition and Advocates for Responsible Care and their Executive Director, Dorothy Leone-Glasser; the Georgia Society of Clinical Oncology; and the Medical Association of Georgia.

We owe a special debt of gratitude to Representatives Knight, Cooper, Hatchett, England, Smith, Newton, Burns, Holmes, Stephens, and House Speaker Ralston.  On the senate side we owe a special debt of gratitude to Senators Burke, Watson, Jones, Hufstetler, Tillery, Mullis, and Lt. Governor Geoff Duncan.   

Should these bills become law, there will be more detail coming via the Georgia law update which will address the intricacies of the legislation including implementation dates, scope, and enforcement.  

Finally, the body of work from the General Assembly and GPhA over the last several years represents what we believe to be amongst the most comprehensive and material legislation in the nation. Though it is not a cure for all problems with PBMs, and PBMs will continue to assert alleged grounds for not adhering, the legislation is a testament to the regard with which pharmacists and their patients are held both by GPhA and Georgia’s General Assembly.  Of thousands of issues the General Assembly can tackle, they continue to do everything they can to fight for you and your patients.  Please remember that, and, thank your representative and senator the next time you seem them.    

PBM Reform

HB 946 (Rep. Knight) & SB 313 (Sen. Burke) represent a comprehensive rewrite of Georgia’s PBM code section (Chapter 64 of Title 33) that include some belt and suspenders changes to strengthen oversight and enforcement as well as innovative first in the nation changes designed to increase transparency, level the playing field and protect patients. Set forth below are highlights of the changes this bill contemplates.

Licensing and oversight

• Removes barriers on Commissioner enforcement.
• Provides the Commissioner of Insurance (“Commissioner”) the power to suspend PBM licenses for violation of the law.
• Gives the Commissioner the authority to conduct financial examinations and compliance audits; issue cease and desist orders; order reimbursement to a pharmacy or insured when a monetary loss has been incurred as a result of a PBM violation; and order payment of a fine up to $1,000 to go to a pharmacy or insured.
• Requires a PBM to make its records available to the Commissioner.
• Empowers the Commissioner to conduct audits following a violation to identify any similar violations.
• Requires PBMs to file MAC methodologies with the Commissioner’s office to enable Commissioner to investigate MAC complaints.
• Increases monetary fines from $1,000 to $2,000 per violation and up to $10,000 per violation when a PBM knew or should have reasonably known it was in violation.
• Increases licensing fee from $500 to $2,000 and renewal fee from $400 to $1,000.

Transparency

• Prohibits PBMs from imposing point of sale or retroactive fees
• Requires reporting of drugs paid 10% above and 10% below NADAC every four months and making the reports available to the public via a website.  
• Prohibits differential treatment of 340b pharmacies.
• Prohibits PBMs from basing reimbursement of a drug on patient scores or outcomes.
• Requires PBMs offer plans the ability to receive 100% of all rebates (broad definition of rebate).
• Requires PBMs offer plans non-spread pricing options.
• Prohibits PBMs from engaging in the practice of spread pricing in state, county, and municipality plans.

Patient Protections

• Requires PBM contracted or employed physicians who make prior authorization and step therapy decisions in connection with appeals to practice in same specialty area in which they are advising.
• Strengthens steering prohibition to prohibit penalizing patients and plans when a patient uses a non-PBM affiliated in network pharmacy of their choice and prohibits PBM to PBM cross referral arrangements.
• Prohibits PBMs from deriving revenue from a pharmacy or patient.
• Prohibits PBMs from withholding coverage or requiring a prior authorization for a lower cost therapeutically equivalent drug.
• Prohibits PBMs from removing a drug from a formulary for the purpose of incentivizing an insured to seek coverage elsewhere.  
• Requires PBMs to apply accepted copay assistance where there is only a brand name drug available to a patient’s copay and deductible.
• Strengthens ability of retail pharmacies to provide delivery services to their patients.

PBM Surcharge

• Imposes a first in the nation surcharge on PBMs and insurer clients on all claims administered when the PBM engages in the practices of steering or imposing retroactive fees.   This surcharge is imposed for the purpose of encouraging payors to use PBMs that are not engaging in these prohibited practices.

Applicability to Medicaid managed care

• Removes Medicaid managed care company exemptions so that all prohibitions and patient protections apply in the Medicaid managed care market. 

Pharmacy Steering & Audits

Building off of HB 233 which was passed in 2019, HB 918 (Rep. Sharon Cooper) strengthens anti-steering provisions which prohibit pharmacies affiliated with PBMs from filling and billing for prescriptions illegally referred and also remove certain exemptions and loopholes.  In addition, this bill makes significant improvements to the Pharmacy Audit Bill of Rights.  

Steering

• Removes language relied upon by DCH and CVS as justification for continued steering.  This language also exempted PBM affiliated pharmacies from other pharmacy requirements.
• Strengthens anti-steering law by prohibiting steering via monetary penalties including withholding coverage/requiring patients to pay full cost of drug & prohibiting PBM to PBM pharmacy referral arrangements.
• Applies anti-steering protections to limited distribution drugs not commonly carried at pharmacies or oncology clinics.
• Applies anti-steering law to Medicaid managed care companies.

Pharmacy Audit Bill of Rights

• Applies protections to desk audits as well as on-site audits.
• Limits audits to no more than 100 prescriptions and no more than 200 prescriptions in a year (refills count as 1 prescription).
• Broadens “clerical error” to include omission errors.
• Expands period to correct a clerical error from 20 to 60 days.
• Expedites period preliminary audit report must be delivered from 120 day up to 30 days.
• Prohibits a PBM from imposing a penalty or fee in connection with an audit.
• Prohibits recoupment from a pharmacy except in cases of fraud; overpayment (limited to amount over paid); and misfill. Provides that when a patient receives the correct drug in the correct dosage and quantity pursuant to a prescription drug order than no misfill shall be found to have occurred.
• Provides that a PBM shall not audit a pharmacy more than once every six months.
• Increases Commissioner of Insurance oversight and ability to impose fines and restitution. 
• * Medicaid fee for service audits and recoupments are still subject to O.C.G.A. 49-4-151.1

State Oversight

HB 991 (Rep. Hatchett) creates the Healthcare Transparency and Accountability Act which seeks to shine a light on the practices of state healthcare plans via the creation of an oversight committee; ensuring the committee has broad access to plan records; and requiring certain mandatory reporting.  

• Creates oversight committee to oversee state healthcare plans and is comprised of a physician, a pharmacist, a consumer member, and 6 members of the general assembly.
• Gives committees the power to:
  • Request and review records of state healthcare plan contractors and subcontractors (including PBMs); prepare public reports using aggregated data.
  • Submit written questions to departments, agencies, and contractors.
  • Make recommendations to departments and agencies.
  • Retain third-party consultants including attorneys and actuaries.
  • Request an audit of a state healthcare plan contractor or subcontractor (including PBMs) from the Department of Audits and Accounts.
• Requires contractors and subcontractors to make all books, documents, and records available to the Committee and the Department of Audits and Accounts.
• Requires a contractor to file an annual report to Committee which shall be available to the public including but not limited to amount paid by the state, MLRs, and dividends paid to shareholders or affiliates.
• Requires annual PBM report to Committee which shall be available to the public detailing, amongst other things:
  • Aggregate rebates and fees collected and the amount retained.
  • Aggregate pharmacy claims data.
  • Aggregate amount paid to affiliate pharmacies.
  • Names of 25 prescription drugs which were subject to most prior authorizations.
• Provides that an amount paid to a contractor and subcontractor is subject to disclosure to the public and is not confidential or a trade secret.
• Provides the Commissioner of Insurance with oversight and the ability to institute fines.

Medicaid Carveout Study

HB 947 (Rep. Knight) looked to, amongst other things, require DCH to engage a Medicaid actuary to conduct a study on the potential savings from carving out Rx benefits from the Medicaid managed care program and putting those benefits back into fee for service.  Rep. Knight and GPhA agreed to press pause on the legislation after the Department went ahead and tasked its Medicaid actuary (the same company that conducted the West Virginia carve out study) with conducting the requested study.  The study is scheduled to be completed by December of 2020.  Note the midyear budget via HB 792 contained $175,000 for DCH to conduct the actuarial study. 

Other legislation that passed and makes its way to the Governor’s office

• HB 759:  Introduced by Rep. Parrish this bill updates the drug code. 
• HB 791:  introduced by Rep. Stephens this legislation authorizes pharmacist conversion of maintenance meds from 30 days to 90 days.  Also included requirements for insurers to cover medications dispensed during declared emergencies which also passed via SB 391 (Sen. Kirkpatrick).

• HB 888:  Introduced by Rep. Hawkins, this legislation looks to protect GA patients from surprise billing practices.  
• SB 372: Introduced by Senator Tillery, this bill, amongst other things, increases the availability of naloxone to first responders via distributors.
• SB 482:  Introduced by Senator Burke, this legislation creates the Georgia All Payer Claims database which will require insurers to file payment data to the state.  The purpose of this legislation is to allow data driven decisions for the purpose of increasing access and quality of care while reducing costs.  
• SB 359:  Senator Hufstetler’s bill was substituted on the House side by Rep. Kelly to provide for protections for providers and other business owners from COVID-19 liability claims.  This bill seeks to provide protection from claims of negligence but preserves claims for gross negligence and intentional torts.   

2020 Legislative Update: Week 9

Week 9 of Georgia’s legislative session was both busy and filled with uncertainty as the General Assembly looked to navigate not only crossover day but also how to proceed in light of CoviD-19. Crossover day is the last day a bill may crossover from its originating chamber and so if a bill does not crossover it is no longer viable that session though its contents may be subsequently added to a viable bill. Crossover day was March 12 and the General Assembly worked deep into the night to get bills out of their originating chambers.

For GPhA, several key bills had already crossed over which made crossover day somewhat less stressful. Those bills are:

• SB 313 (Sen. Burke’s PBM bill)
• HB 918 (Rep. Cooper’s update to the Pharmacy Anti-Steering Act and Pharmacy Audit Bill of Rights)
• HB 946 (Rep. Knight’s PBM bill & companion to SB 313)
• HB 947 (Rep. Knight’s bill seeking a study of the fiscal impact of carving Rx benefits from Medicaid managed care & mandating a carve out if the study reflects potential annual savings of $20 million or more)
• HB 991 (Rep. Hatchett’s legislation creating the Healthcare Transparency and Accountability Oversight Committee)

In addition, several other bills GPhA is monitoring made crossover while others did not. Set forth below is a breakdown of those bills.

Last week the General Assembly made the decision to suspend the legislative session until further notice due to CoviD-19 concerns. The session will reconvene, and the hope is that when it does the body will continue to work on moving legislation forward in the remaining days of the session. The General Assembly also passed the midyear budget via HB 792 which, amongst other things, contained $175,000 for DCH to conduct an actuarial study on the fiscal impact of carving Rx benefits from Medicaid managed care. In a year with much belt tightening and several distracting factors, getting this money appropriated is a significant step forward for assessing the potential savings the state may achieve via a Medicaid managed care Rx carve out and for transparency.

GPhA monitored bills that made crossover

• HB 759 (drug update)
• HB 791 (authorizing conversion of maintenance meds from 30 days to 90 days)
• HB 847 (hemp farming)
• HB 888 (surprise billing)
• SB 28 (now dealing with reasonableness of copays)
• SB 272 (OTC cough syrup restrictions)
• SB 311 (restricting remuneration in connection with referral to/from substance abuse providers)
• SB 532 (online provider directories)
• SB 359 (surprise billing)
• SB 372 (amongst other things, increasing availability of naloxone via distributors)
• SB 391 (requiring coverage for medications dispensed during declared emergencies)

GPhA monitored bills that did not make crossover

• HB 813 (Medicaid expansion)
• HB 864 (excise tax on vape devices and products)
• HB 952 (restricting corporate practice of pharmacy)
• HB 961 (transparency for prescription drugs which state expends significant funds)
• HB 1027 (Dealing with PBM treatment of rebates)
• HB 1105 (patient protection through health information)
• HB 1128 (PBM reform – introduced the week of crossover)
• SB 376 (insulin costs)
• SB 415 (tort reform)
• SB 427 (Rx carve out from Medicaid managed care – companion to HB 947 which did make cross over)
• SB 433 (drug pricing transparency)
• SB 481 (exempting low THC and marijuana products approved by FDA from certain definitions)

2020 Legislative Update: Week 8

Week 8 (March 2-5 and legislative days 22-25) saw forward progress on several pieces of pharmacy related legislation.

HB 918; HB 946; and HB 947

The House passed all three of these bills this week almost unanimously with HB 946 receiving one no vote. They now make their way over to the senate for consideration. Please take the time to thank Reps. Knight and Cooper for their efforts in championing these pro-patient and pro-pharmacy pieces of legislation as well as your representative for their favorable vote.

SB 313

Senator Burke’s PBM bill passed out of the Senate unanimously this week as well. Their was an amendment on the floor which removed the requirement that PBMs pass along 100% of their rebates to plans and the prohibition on spread pricing practices. In place of those requirements, PBMs will be required to offer plans non-spread and 100% pass through options and will be required to report rebates and spread retained by PBMs. GPhA was involved in the crafting of this amendment. Please take the time to reach out to Senator Burke and thank him for his support and leadership as well as Senator Burt Jones who chaired the Insurance and Labor Committee and who was instrumental in the Senate’s passage of this legislation. Please also thank your Senator for their vote in favor of this bill.

Legislation introduced in week 8

SB 481

Introduced by Senator Brass, this legislation removes products approved by the FDA from the definitions of low THC oil, marijuana, and tetrahydrocannabinols.

Other previously introduced legislation

HB 888, Rep. Hawkins’ surprising billing legislation, passed the House and makes it way to the Senate.

HB 991, Rep. Hatchett’s bill creating the Healthcare Transparency and Accountability Oversight Committee, was favorably reported by the House Special Committee on Access to Quality Healthcare. GPhA testified in favor of this legislation and this legislation remains a GPhA priority to support.

SB 311, Sen. Kirkpatrick’s bill prohibiting kickbacks and patient brokering in connection with substance abuse providers was favorably reported by Senate HHS via substitute.

SB 391, Sen. Kirkpatrick’s legislation requiring insurers to cover early fills of medication during declared emergencies was favorably reported by the Senate HHS Committee.

2020 Legislative Update: Week 7

Week 7 of Georgia’s legislative session (February 24-28 and days 17-21) saw continued attention on legislation related to the practices of PBMs both through committee hearings and committee votes on previously introduced legislation as well as new legislation introduced.

HB 918; HB 946; and HB 947

HB 918 (Rep. Sharon Cooper’s bill updating the Pharmacy Audit Bill of Rights and strengthen the Pharmacy Anti-Steering Act) and Rep. Knight’s HB 946 (PBM legislation) and HB 947 (Actuarial study & Medicaid cave out) were all heard by the House Special Committee on Access to Quality Healthcare on Thursday, the 27th. While it was originally scheduled to be a two-hour hearing, Chairman Newton allowed the hearing to continue to ensure that pharmacists and other patient advocates had the opportunity to be speak and be heard. Please reach out to Chairman Newton and thank him for ensuring that pharmacists were heard.

In explaining his legislation, Rep. Knight delivered a hard hitting and methodical presentation including outlining examples of PBM steering and issues in Medicaid managed care. On HB 918, Rep. Cooper delivered an impassioned speech on the ills of patient steering and abusive audit practices.

The Committee also heard from an array of others on the negative impact on patient care including the Medical Association of Georgia, the National Multiple Sclerosis Society, and the Rx in Reach Coalition. Georgia Pharmacists Thomas Jusu, Chelley Williams, and Kevin Woody also presented moving and compelling testimony in support of the legislation.

Friday morning the committee voted on and passed all three bills out of Committee. Next stop is the Rules Committee and then the House floor.

At the same time as the House Special Committee on Access to Quality Healthcare meeting Friday morning, the Senate Insurance and Labor subcommittee voted in favor of SB 313 and it now goes to the full committee for a vote. Subcommittee Chair Larry Walker and Senator Freddie Sims Powell voted in favor of SB 313. Please reach out and thank them for their support.

Legislation Introduced in Week 7

HB 991

Introduced by Representative Hatchett, HB 991 looks to put an end to opaque practices and lack of transparency by CMOs, PBMs, and others contracted with state plans by bringing true transparency and oversight by creating the Healthcare Transparency and Accountability Oversight Committee which will have the authority to review conduct and performance of state health care plan contractors. GPhA is strongly in support of this legislation.

HB 1027

Introduced by Rep. Hawkins, this bill looks to require PBMs to pass at least 80% of rebates received or to be received on to patients at the point of sale via reduction of a patients cost share amount. of rebates it receives to patients at the point of sale. The state and Medicaid managed care would be carved out this requirement.

SB 427

Introduced by Senator Mullis, HB 427 is a companion bill to HB 947 and looks to task an actuarial study of savings to the state by carving prescription drugs out of Medicaid managed care and having those benefits administered in Georgia’s Medicaid fee for service program. If the study reflects savings of $20 million or more DCH will proceed with a carve out to implemented by July of 2021. If the savings are between $10 million and $20 million DCH is authorized to proceed. Please reach out to Senator Mullis and thank him for bringing this important piece of legislation and for being such a staunch supporter of pharmacists and their patients.

SB 433

Introduced by Senator Jones, this bill seeks to bring transparency to the prescription drugs treating diabetes. Specifically, this bill contains reporting requirements for insulin drug manufacturers, pharmacy benefits managers, and pharmacists. GPhA is supportive of efforts at transparency and will look to engage and monitor.

Other Previously Introduced Legislation

HB 888, Rep. Hawkins’ surprise billing legislation, was favorably reported by the House Special Committee on Access to Care.

HB 952 which looks to restrict corporations that own multiple pharmacies from implementing corporate policies and procedures that restrict the quantity of controlled substances was favorably reported by the House Special Committee on Access to Quality Healthcare.

SB 303, providing for greater transparency of prices for nonemergency health care services, passed the Senate and makes its way to the House.

SB 321, Sen. Burke’s online provider legislation, was favorably reported by the Senate Insurance & Labor Committee and passed by the Senate. It now goes to the House for Consideration.

SB 359, Sen. Hustetler’s surprise billing legislation, was favorably reported by Senate HHS and passed on the House floor.

2020 Legislative Update: Week 6

Week 6 of Georgia’s legislative session (days 14-17) proved to be a busy one for pharmacy with several exciting pieces of pro-patient and pro-pharmacy legislation being introduced with an exciting array of bill sponsors and cosponsors.

HB 918: Strengthening existing PBM laws

Introduced by Rep. Sharon Cooper, this strengthens Georgia’s Pharmacy Audit Bill of Rights and strengthen the Pharmacy Anti-Steering Act passed into law last year via HB 233. Specifically, this bill looks to:

• Remove language in the law being relied upon by DCH to allow steering in the state health benefit plan;
• Update the audit bill of rights to increase Commissioner of Insurance authority and limit PBM recoupments from pharmacies to situations when there has been fraud; a mis-fill; or an overpayment; and
• Strengthen Georgia’s anti-steering law by prohibiting PBMs from steering via monetary penalties including withholding coverage; prohibiting PBM to PBM pharmacy referral arrangements; and apply steering protections to patients who receive limited distribution drugs and to patients in Medicaid managed care.

This is a critical piece of legislation for pharmacy patients which GPhA will advocate hard for.

HB 946: Mandating PBM Pricing reports 

Rep. Knight’s HB 946 is a companion bill to SB 313 and it HB 946 looks to bring true transparency to prescription drug pricing in Georgia by

• mandating PBMs report deviations in connection with public pricing benchmarks,
• prohibiting spread pricing and retroactive recoupments, and
• requiring rebates to be passed back to payors.

It also seeks to protect patients by prohibiting practices including withholding coverage for lower cost generic drugs; failing to count copay assistance towards deductibles; and removing a drug from a formulary for the purpose of pushing patients to a different plan.

Finally, this bill looks to protect patient choice by strengthening anti-steering law, and imposing a first in the nation surcharge on PBMs and their insurer clients when they engage in the practice of patient steering to affiliated pharmacies.

HB 947: Studying a Prescription drug carve-out

Introduced by Rep. Knight, HB 947 sets forth some of the many problems in prescription drug administration in Georgia’s Medicaid managed care program including poor outcomes, self dealing, and high administrative costs. This bill looks to tackle these problems by tasking an actuarial study of savings to the state by carving prescription drugs out of Medicaid managed care and having those benefits administered in Georgia’s Medicaid fee for service program. If the study reflects savings of $20 million or more DCH will proceed with a carve out to implemented by July of 2021. If the savings are between $10 million and $20 million DCH is authorized to proceed.

Advocate!

All three of these bills are critical to patients and pharmacies in Georgia and it is important your legislators hear from you on how important each of these bill are. These bills have been assigned to the House Special Committee on Access to Quality Healthcare. Please reach out to the committee members below, let them know you support the legislation, and thank them for their support and work on behalf of Georgia’s patients.

Newton, Mark – Chairman
Cooper, Sharon – Vice Chairman
Bentley, Patty
Corbett, John
Frye, Spencer
Hatchett, Matt
Houston, Penny
Jones, Todd
Knight, David
Nix, Randy
Parrish, Butch
Pirkle, Clay
Prince, Brian
Smith, Richard H.
Smyre, Calvin

SB 313: PBM Regulation

We are hopeful this PBM reform bill will be heard in full committee this week. Please reach out to committee members (below) and ask for their favorable support — thank them for their time and consideration. Between its initial hearing and subcommittee hearing, approximately five hours of committee time has been spent on this legislation, and we are optimistic this bill will be in a position to move forward.

Jones, Burt – Chairman
Martin IV, P. K. – Vice Chairman
Harbin, Marty
Sims, Freddie Powell
Unterman, Renee
Watson, Ben
Burke, Dean
Harbison, Ed
Kirkpatrick, Kay
Lucas, David
Robertson, Randy
Walker III, Larry

Other Legislation introduced in week 6

SB 391: Emergency refills

Introduced by Sen. Kirkpatrick, this bill requires health insurers to provide coverage for early refills of a 30 day supply of certain prescription medications under certain emergency situations. While the Board of Pharmacy does an excellent job of acting quickly in emergency situations such as hurricanes, this bill contemplates removing hurdles on the insurer side. GPhA will continue to engage on this legislation.

HB 952: Prohibiting Controlled substance limitations

Introduced by Rep. Cooper, this bill prohibits “corporations that own and operate multiple pharmacies from implementing policies and procedures that restrict the quantity of controlled substances dispensed or restrict the prescriber while at the same time protecting the ability of dispensing pharmacists to utilize their professional judgment. GPhA will monitor.

HB 961: Gathering info on state prescription drug spending

Rep. Park’s bill looks to create a list of prescription drugs for which the state expends significant healthcare funds and authorizes the AG to require info. from drug manufacturers. GPHA will monitor and engage.

Previously introduced legislation

SB 272: Dextromethorphan ban

Sen. Robertson’s legislation which looks to prohibit the sale to and by minors of drug products containing dextromethorphan was favorably reported out of committee. GPhA has remained engaged on this legislation over the past several years and will continue to monitor and engage as necessary.

Senate Insurance and Labor Committee

Jones, Burt – Chairman
Martin IV, P. K. – Vice Chairman
Harbin, Marty – Secretary
Sims, Freddie Powell – Ex-Officio
Unterman, Renee – Ex-Officio
Watson, Ben – Ex-Officio
Burke, Dean  (Also SB 313 Author)
Harbison, Ed
Kirkpatrick, Kay
Lucas, David
Robertson, Randy
Walker, III, Larry

2020 Legislative Update: Week 5

Although there were no legislative days, week 5 proved to be a significant one for pharmacy. SB 313 was heard by the full Senate Insurance & Labor Committee on Monday, February 10. Several testified against the legislation including a PCMA representative. (PCMA is the association that advocates on behalf of PBMs.)

Testifying in support of the legislation were GASCO (Georgia Society of Clinical Oncology); MAG (Medical Association of Georgia); the National Multiple Sclerosis Society; and, of course, GPhA. There were also several members of the news media in attendance. Following a hotly contested meeting, Chairman Burt Jones assigned the bill to subcommittee consisting of Senator Larry Walker as chair, Senator P.K. Martin, and Senator Freddie Sims Powell.

The subcommittee held its first meeting on Wednesday in which Senator Burke introduced a substitute to SB 313. (Note: The substitute is not yet on the website.) It incorporated non-material changes requested by state agencies and also reinserted MAC pricing law protections, added a requirement that MAC methodologies be filed with the commissioner of insurance for use in investigating MAC appeals, deleted the requirement that PBMs utilize NADAC as a floor (due to fiscal concerns and the time it would likely take for a fiscal analysis), and requires PBMs to file public reports of reimbursements below and above certain thresholds of NADAC — including a a requirement that reimbursements to affiliates be identified.

The hearing itself was fiercely contested, with several PBM and insurer lobbyists and representatives testifying against the bill. Testifying in support of the bill were several patients as well as pharmacists Jennifer Shannon and Dawn Sasine along with Jessica Longtin, a manager at City Drugs in Vidalia. All three shared moving examples of how PBM practices have hurt patient care. GPhA also testified in support as did MAG. Another strong ally in attendance was patient advocacy organization Rx in Reach, which assisted with patient testimony and had a strong presence at the hearing.

This legislation remains under fire so, if your senator sits on the subcommittee or on the Senate Insurance & Labor Committee itself, please reach out and let them know how important this legislation is for your patients and for your practice, and ask for their support. It is important they hear from you as they are hearing from an unprecedented number of PBM and insurer lobbyists every day.

Senate Insurance and Labor Committee

Jones, Burt – Chairman
Martin IV, P. K. – Vice Chairman
Harbin, Marty – Secretary
Sims, Freddie Powell – Ex-Officio
Unterman, Renee – Ex-Officio
Watson, Ben – Ex-Officio
Burke, Dean – Member (Also SB 313 Author)
Harbison, Ed – Member
Kirkpatrick, Kay – Member
Lucas, David – Member
Robertson, Randy – Member
Walker, III, Larry – Member

2020 Legislative Update: Week 4

Week 4 of Georgia’s legislative session (days 10-12) was relatively light on the introduction of healthcare legislation, although it was an exciting one for Georgia pharmacy with the first of two of GPhA’s Pharmacy Day at the Dome events. More than 250 students from UGA and PCOM descended on the Capitol to advocate for SB 313 and its goals of increasing transparency and protecting patients.

In other news, with concerns regarding the budget, the General Assembly passed a revised adjournment resolution (SR 712); it will recess until February 18. While there will be no legislation days during that time, certain committees, including appropriations, will continue to meet.

Legislation introduced in week 4

HB 888 and SB 359: Surprise billing

Introduced by Representatives Hawkins and Senator Hufstetler respectively, these companion bills look to address the problem of balanced billing, also known as surprise billing, which commonly occurs when an out-of-network provider cares for a patient at an in-network facility such as a hospital. This can often lead to patients receiving large and unexpected medical bills.

GPhA is supportive of efforts to protect patients and will continue to monitor and engage as these bills make their way through the General Assembly.

SB 348: Provider continuity

Introduced by Senator Kirkpatrick, this bill looks to ensure patients can continue to use a previously in-network provider for a period of at least 90 days following the departure of the provider from the network, subject to certain exceptions.

It also looks to ensure network sufficiency and gives the commissioner of insurance the ability to assess provider network adequacy. Significantly, pharmacists are included within the definition of “provider.” GPhA is in support of this legislation and will continue to follow it closely.

Previously introduced legislation

HB 759: Annual Drug Update

Representative Parrish’s drug update bill made its way through the Judiciary Non-Civil Committee and continues its journey to the House floor.

URGENT CALL TO ACTION

GPhA Members:

This year’s fight is just beginning, with one bill dropped in the Senate (SB313) and additional bills being dropped in the House very soon. The PBMs have brought in more lobbyists than ever to argue against our efforts to bring transparency and fair reimbursements to pharmacy, as well as curtail some of the heinous acts conducted by the PBMs.

We need your help again this year to pass our bills into law! And I’m sure this isn’t the last time we’ll be asking for your help this assembly.

SB313 is scheduled to be heard in a subcommittee on Wednesday. SB313 will:

• Bring true transparency to prescription drug pricing in Georgia by using public pricing benchmarks and requiring rebates to be passed back to payors
• Protect patients from certain practices including:
  • blocking access to cheaper generics
  • withholding coverage if a patient chooses not to use a PBM-owned pharmacy

We need you to take immediate action. Please reach out to the three senators on the subcommittee and urge their support of SB313. If written correspondence, please copy Senator Jones, chair of the Senate Insurance and Labor Committee on your e-mail or other communication. Senator Jones and the subcommittee’s contact information are listed below:

Senator Burt Jones
Chairman of the Senate Insurance and Labor Committee
(770) 775-4880
Burt.Jones@senate.ga.gov

Senator Larry Walker
Committee Member – Insurance and Labor Committee
(404) 656-0095
Larry.Walker@senate.ga.gov

Senator P.K. Martin
Vice Chairman, Committee Member – Insurance and Labor Committee
(404) 463-6598
p.k.martin@senate.ga.gov

Senator Freddie Powell Sims
Ex-Officio – Insurance and Labor Committee
(404) 463-5259

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.

2020 Legislative Update: Week 1

Leading into Georgia’s 2020 legislative session, it was clear that issues pertaining to pharmacy were going to be front and center. The week before legislative session, on January 7, The House Insurance Committee and the House Special Committee on Access to Care convened to hear from patients, pharmacists, and physicians on PBM and managed care practices impacting Georgia’s patients, providers, and taxpayers.

Following the hearing, the House GOP issued a press release declaring its intention to ‘reverse the corporate takeover of Georgia Healthcare’ by introducing legislation that aims to: (1) bring true transparency to the prescription drug market; (2) seek a carve out of prescription drug benefits from Medicaid managed care; and (3) bring true oversight to PBMs and CMOs. Click here for the full press release.

Needless to say, GPhA fully supports these initiatives and looks forward to an exciting and busy 2020 legislative session that holds the potential to continue to bring true change to Georgia and improve conditions for pharmacy patients and pharmacies across the state. GPhA is grateful for the leadership and determination of the House GOP to continue to tackle problematic PBM practices.

Caroline Womack joins the GPhA advocacy team

In other huge news — news that has reverberated throughout Georgia’s government affairs community and the Capitol — GPhA has expanded its legislative team at the capitol by bringing on veteran lobbyist Caroline Womack to assist Greg Reybold and Cindy Shepherd. Caroline is one of the foremost healthcare lobbyists at the Capitol and offers a unique perspective and expertise in that she represented PCMA, the PBM industry’s trade association, for several years. The perspective, expertise, value, and work ethic she will bring to GPhA’s advocacy efforts is something for all of us to be excited about as we begin the session.

Week 1

Georgia’s 2020 legislative session convened on Monday, January 13, and GPhA was there. While none of GPhA’s legislative priorities were introduced, legislative days 1 through 3 were busy nonetheless with GPhA engaging in many discussions with legislators. While typically the first week can be light on pharmacy legislation, this year there were several pieces of legislation that GPhA will be tracking.

SB 293: Surprise Billing

Introduced by Senator Hoefstetler, the Balance Billing Consumer Protection Act looks to address the issue of surprise billing of patients. While this issue is seen most frequently in the emergency room setting, and it is not typically a problem in the retail pharmacy world, this bill is broadly written and potentially implicates retail pharmacies. As a result, GPhA will look to monitor and engage on this legislation, as well as other expected legislation, and ensure that pharmacy’s perspective is considered and understood.

HB 759: Annual Drug Update

Representative Parrish introduced the annual drug update bill which looks to update Georgia law with regard to controlled substances and dangerous drugs.

HB 791: Maintenance meds, 90-day supply

Representative Stephens introduced this bill which seeks to authorize a pharmacist to dispense up to a 90-day supply of a maintenance medication under certain conditions. This authorization would not extend to controlled substances.

Pharmacists and student pharmacists at the capitol

While GPhA is at the capitol daily advocating for pharmacists and their patients, the true voice and the true strength of the association lies with you, our members. That is why is so important that your legislators hear from you, their constituents, on issues that impact pharmacy.

With GPhA’s legislative priorities soon to be introduced, it is critical that our member pharmacists and student pharmacists continue to participate in GPhA’s Pharmacists at the Capitol and Day at the Dome events. Stay tuned as we will be releasing our first dates soon.

With no legislative days the week of January 20, the next legislative update will come on February 4 and will cover legislative days 4 – 8.

An Arkansas pharmacy law is headed to the Supreme Court

Should PBMs be allowed to claim ERISA to preempt state laws?

Media jumps on House plan to help local pharmacies

The Georgia House’s plan to rein in PBMs and Medicaid MCOs is getting some great press!

• WALB: “House GOP plans to reverse ‘corporate takeover’ of Ga. health care“
• Georgia House Press: “House Majority Caucus Unveils Plan to Reverse Corporate Takeover of Georgia Health Care“
• Jackson Progress-Argus: “Georgia House Majority Caucus plans to return health care decisions to patients“
• The Center Square: “Reducing drug costs is goal of Georgia proposal to rein in pharmacy benefit managers“
• The Brunswick News: “House leaders push for prescription meds overhaul“
• Valdosta Daily Times: “Lawmakers struggle to buoy local pharmacies“
• Georgia Recorder: “Georgia House Republicans say big pharmacy managers cause pain“

Click here for the detailed story, including a link to the full hearing video.