2018 Georgia Code
Title 33 - Insurance
Chapter 64 - Regulation and Licensure of Pharmacy Benefits Managers
§ 33-64-11. Prohibited activities of pharmacy benefits manager

Universal Citation: GA Code § 33-64-11 (2018)
  • (a) A pharmacy benefits manager shall be proscribed from:

    • (1) Prohibiting a pharmacist or pharmacy from providing an insured individual information on the amount of the insured's cost share for such insured's prescription drug and the clinical efficacy of a more affordable alternative drug if one is available. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for disclosing such information to an insured or for selling to an insured a more affordable alternative if one is available;

    • (2) Prohibiting a pharmacist or pharmacy from offering and providing store direct delivery services to an insured as an ancillary service of the pharmacy;

    • (3) Charging or collecting from an insured a copayment that exceeds the total submitted charges by the network pharmacy for which the pharmacy is paid;

    • (4) Charging or holding a pharmacist or pharmacy responsible for a fee relating to the adjudication of a claim;

    • (5) Recouping funds from a pharmacy in connection with claims for which the pharmacy has already been paid without first complying with the requirements set forth in Code Section 26-4-118, unless such recoupment is otherwise permitted or required by law; and

    • (6) Penalizing or retaliating against a pharmacist or pharmacy for exercising rights under this chapter or Code Section 26-4-118.

  • (b) To the extent that any provision of this Code section is inconsistent or conflicts with applicable federal law, rule, or regulation, such applicable federal law, rule, or regulation shall apply.

  • (c) This Code section shall not apply to:

    • (1) A care management organization, as defined in Chapter 21A of this title;

    • (2) The Department of Community Health, as defined in Chapter 2 of Title 31;

    • (3) The State Health Benefit Plan under Article 1 of Chapter 18 of Title 45; or

    • (4) Any licensed group model health maintenance organization with an exclusive medical group contract and which operates its own pharmacies licensed under Code Section 26-4-110.1.

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