State legislatures across the country have begun to tackle the issues created for both consumers and pharmacists alike by Pharmacy Benefit Managers (PBMs) and their business practices. In a previous alert we mentioned Public Act 17-241, a bill recently signed into law in Connecticut that addressed “secret price gouging” by PBMs.
Georgia has now joined in and enacted the Pharmacy Patient Fair Practices Act (Act. No. 196 / S.B. 103). The Act (full text available here), received support from a number of consumer and pharmacy-related advocacy organizations.
The Act, effective July 1, 2017, and applicable to all PBM contracts issued, delivered, or issued for delivery in Georgia on and after that date, prohibits a number of previously common PBM contact provisions, including:
- Mandatory mail-order requirements for the fulfillment of prescriptions;
- Restrictions that prevented pharmacists from communication with patients regarding more affordable alternatives to their prescribed drugs (i.e. generics);
- Restrictions on store-provided delivery services;
- Charging patients more for a prescribed drug as a co-pay than the actual cost of the drug if paid for in cash, i.e. “clawbacks”
- Various “retaliatory” measures often used against pharmacies, including charging pharmacists for “fees” relating to the adjudication of claims or penalizing them for exercising their rights under Georgia law.
The Act also grants the Georgia Commissioner of Insurance the authority to promulgate rules and regulations related to the PBM Code in order to effectuate its provisions. The Commissioner did not previously have such authority.