06 LC 33
1330
House
Bill 1413
By:
Representatives Stephens of the
164th,
Maxwell of the
17th,
Parrish of the
156th,
Parham of the
141st,
Carter of the
159th,
and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia
Annotated, relating to insurance generally, so as to provide for insurance
coverage of therapeutically equivalent drugs under certain circumstances; to
provide for definitions; to provide for construction; to provide for enforcement
by the Commissioner of Insurance; to amend Article 5 of Chapter 4 of Title 26 of
the Official Code of Georgia Annotated, relating to prescription drugs, so as to
eliminate redundant language relating to the practice of medicine; to provide
for the dispensing of therapeutically equivalent drugs by a pharmacist to a
patient for purposes of formulary compliance if approved by the ordering
practitioner; to provide for notice to the ordering practitioner of the
substitution; to provide for related matters; to repeal conflicting laws; and
for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Article
1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating
to insurance generally, is amended by adding at the end thereof a new Code
Section 33-24-59.13 to read as follows:
"33-24-59.13.
(a)
As used in this Code section, the term:
(1)
'Health benefit policy' means any individual or group plan, policy, or contract
for health care services issued, delivered, issued for delivery, or renewed in
this state, including, but not limited to, those policies, plans, or contracts
executed by the State of Georgia on behalf of state employees under Article 1 of
Chapter 18 of Title 45, by an insurance provider.
(2)
'Insurance provider' means an insurance company, carrier, or similar third-party
payor plan.
(b)
Every health benefit policy that is delivered, issued, executed, or renewed in
this state or approved for issuance or renewal in this state by the Commissioner
on or after July 1, 2006, which provides coverage for prescription drugs shall
ensure that if a therapeutically equivalent drug is substituted for the
specifically prescribed drug for purposes of formulary compliance with the
patient́s
health benefit policy by a pharmacist in accordance with Code Section 26-4-81.1,
the insurance provider will cover such drug dispensed.
(c)
Nothing in this Code section shall be construed to require any health benefit
policy to include coverage for prescription drugs.
(d)
The Commissioner is authorized to enforce this Code section and, in doing so, to
exercise the powers granted to the Commissioner by Code Section 33-2-24 and any
other provisions of this
title."
SECTION
2.
Article
5 of Chapter 4 of Title 26 of the Official Code of Georgia Annotated, relating
to prescription drugs, is amended by striking Code Section 26-4-81, relating to
substitution of generic drugs for brand name drugs, and inserting in its place
the following:
"26-4-81.
(a)
In accordance with this Code section, a pharmacist may substitute a drug with
the same generic name in the same strength, quantity, dose, and dosage form as
the prescribed brand name drug product which is, in the
pharmacist́s
reasonable professional opinion, pharmaceutically equivalent.
(b)
If a practitioner of the healing arts prescribes a drug by its generic name, the
pharmacist shall dispense the lowest retail priced drug product which is in
stock and which is, in the
pharmacist́s
reasonable professional opinion, pharmaceutically equivalent.
(c)
Substitutions as provided for in subsections (a) and (b) of this Code section
are authorized for the express purpose of making available to the consumer the
lowest retail priced drug product which is in stock and which is, in the
pharmacist́s
reasonable professional opinion, both therapeutically equivalent and
pharmaceutically equivalent.
(d)
Whenever a substitution is made, the pharmacist shall record on the original
prescription the fact that there has been a substitution and the identity of the
dispensed drug product and its manufacturer. Such prescription shall be made
available for inspection by the board or its representative in accordance with
the rules of the board.
(e)
The substitution of any drug by a registered pharmacist pursuant to this Code
section does not constitute the practice of medicine.
(f)
A patient for whom a prescription drug order is intended may instruct a
pharmacist not to substitute a generic name drug in lieu of a brand name
drug.
(g)
A practitioner of the healing arts may instruct the pharmacist not to substitute
a generic name drug in lieu of a brand name drug by including the words 'brand
necessary' in the body of the prescription. When a prescription is a hard copy
prescription drug order, such indication of brand necessary must be in the
practitioneŕs
own handwriting and shall not be printed, applied by rubber stamp, or any such
similar means.
(h)
The substitution of any drug by a registered pharmacist pursuant to this Code
section does not constitute the practice of
medicine."
SECTION
3.
Said
article is further amended by inserting a new Code section after Code Section
26-4-81, relating to substitution of generic drugs for brand name drugs, to read
as follows:
"26-4-81.1.
(a)
In accordance with this Code section, a pharmacist may substitute a
therapeutically equivalent drug for purposes of formulary compliance with the
patient́s
insurance company, carrier, or similar third-party payor plan.
(b)
If a practitioner of the healing arts prescribes a drug, but has indicated on
the prescription that a therapeutically equivalent drug may be substituted for
formulary compliance with the
patient́s
insurance company, carrier, or similar third-party payor plan, the pharmacist
shall dispense the therapeutically equivalent drug if it is in the same
therapeutic class as the prescribed drug. Such indication shall be made by the
practitioneŕs
initials or signature on a preprinted prescription form clearly specifying that
a therapeutically equivalent drug may be substituted for the prescribed drug for
purposes of formulary compliance. The board shall be authorized to promulgate
regulations to establish requirements for preprinted prescription drug order
forms to clearly provide for such indication.
(c)
The pharmacist shall, within 24 hours of dispensing a therapeutically equivalent
drug substitution, notify the ordering practitioner of the substitution and the
name of the therapeutically equivalent drug dispensed. Further, the pharmacist
shall, whenever a substitution is made pursuant to this Code section, record on
the original prescription the fact that there has been a therapeutically
equivalent substitution and the identity of the dispensed drug product and its
manufacturer. Such prescription shall be made available for inspection by the
board or its representative in accordance with the rules of the
board.
(d)
Substitutions made pursuant to this Code section are authorized for the express
purpose of dispensing drugs which are included in the approved formulary of the
patient́s
insurance company, carrier, or similar third-party payor plan.
(e)
The substitution of any drug by a registered pharmacist pursuant to this Code
section does not constitute the practice of
medicine."
SECTION
4.
All
laws and parts of laws in conflict with this Act are repealed.