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