08 LC 33 2530S
House
Bill 367 (COMMITTEE SUBSTITUTE)
By:
Representatives Carter of the
159th,
Stephens of the
164th,
Parrish of the
156th,
Parham of the
141st,
and Jerguson of the
22nd
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 define certain terms; to
provide for health insurance coverage for nonformulary drug products for a
limited supply under certain conditions; to provide for statutory construction;
to provide for enforcement by the Commissioner of Insurance; to provide for
monetary penalties for violations; 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 inserting a new Code section to read as
follows:
"33-24-59.13.
(a)
As used in this Code section, the term:
(1)
'Health benefit plan' means any individual or group plan, policy, or contract
for health care services issued, delivered, issued for delivery, or renewed in
this state by a health benefit plan provider, 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.
(2)
'Health benefit plan provider' means an insurance company, carrier, or similar
third-party payor plan.
(b)
Every health benefit plan 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, 2008, which provides coverage for prescription drugs shall
ensure that if a physician prescribes a drug product that is not on the health
benefit plan provider´s formulary for the patient´s health benefit
plan, a pharmacist may dispense such prescribed drug product and the health
benefit plan provider shall cover such nonformulary drug product for up to a
ten-day supply for each prescription but not more than once per year in order to
allow time for the pharmacist or patient to contact the physician for approval
of an alternate drug product that is on the formulary or to obtain prior
approval from the health benefit plan provider or its pharmacy benefits manager
for the prescribed drug product; provided, however, that the health benefit plan
provider shall not impose any penalty against the pharmacist or the patient,
including, but not limited to, a higher copayment on the nonformulary drug
product, for complying with the requirements of this subsection.
(c)
Nothing in this Code section shall be construed to require any health benefit
plan to include coverage for prescription drugs.
(d)
The Commissioner is authorized to enforce this Code section and shall be
authorized to impose on a health benefit plan provider a monetary penalty of
$500.00 for a violation of this Code section. If a monetary penalty is imposed
by the Commissioner on a health benefit plan provider pursuant to this
subsection, the health benefit plan provider may invoke the right to an
administrative hearing in accordance with Chapter 2 of Title 33. Further, the
Commissioner may exercise the powers granted by Code Section 33-2-24 and any
other provision of this title."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.