State employees' health insurance plan; drugs dispensed for self-administration; provisions
Summary
A BILL to be entitled an Act to amend Part 1 of Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to state employees' health insurance plan, so as to require that drugs dispensed to a covered person for self-administration under a state health plan be reimbursed using a transparent, index based price, plus a dispensing fee; to provide for definitions; to provide for related matters; to repeal conflicting laws; and for other purposes.
Bill status
signed
all 5 stages cleared
Introduction
Jan 2025
Committee Review
Mar 2025
House Passage
Feb 2025
Senate Passage
Mar 2025
Signed into Law
May 2025
Introduced Jan 30, 2025
Signed May 14, 2025
Maddy AI version diff · 3 comparisons
What changed between versions
LC 57 0229S/hcs
→
HB 196/AP*
·
5 edits
MODERATE
The bill was finalized as passed by both legislative chambers, updating the effective date to January 1, 2026, and significantly changing how pharmacy reimbursement is calculated. The new version replaces the previous requirement to use a specific 'Georgia estimated acquisition cost' with a more flexible standard allowing insurers to use a discounted percentage of average wholesale price based on market rates. Additionally, the bill now mandates specific minimum dispensing fees of $10.50 for chain pharmacies and $11.50 for independent pharmacies, and grants the Commissioner of Insurance enforcement authority over the new rules.
Scope change
The bill's scope remains focused on the state employees' health insurance plan, but the applicability of reimbursement rules has expanded to allow for market-based pricing adjustments and differentiated fees based on pharmacy type.
REQUIREMENT
Reimbursement calculation method changed from a fixed state-determined cost to a flexible formula allowing a discounted percentage of average wholesale price based on competitive market rates.
New mandatory minimum dispensing fees were established at $10.50 for chain pharmacies and $11.50 for independent pharmacies.
A new provision was added stating that insurers cannot reimburse pharmacies at a rate lower than the mandatory minimums established in the bill.
ENFORCEMENT
The Commissioner of Insurance was granted explicit enforcement authority to ensure compliance with the new pharmacy reimbursement standards.
DEFINITION
The definition of 'Pharmacy benefits manager' was updated to include the abbreviation 'PBM' and clarify the scope of the term.
Floor votes · Senate Mar 27, 2025 · House Feb 21, 2025
How they voted
54–0
Passed · 1 other
Total votes 55
Mar 27, 2025
D
Democratic22
100% Yea
R
Republican33
96% Yea
Vote distribution
All Yea
All Nay
Mixed
No data
Full legislative history
Actions timeline
Total actions
16
Key actions
6
Committee
3
Amendments
1
May 14, 2025
Signed into law
Act 307
upper
May 14, 2025
Signed into law
House Date Signed by Governor
lower
Mar 31, 2025
Introduced
House Agreed Senate Amend or Sub
lower
Mar 27, 2025
Upper · Passed
Senate Passed/Adopted By Substitute
upper
Mar 20, 2025
Upper · Passed
Senate Committee Favorably Reported By Substitute
upper
Feb 24, 2025
Committee
Senate Read and Referred
upper
Feb 21, 2025
Lower · Passed
House Passed/Adopted By Substitute
lower
Feb 11, 2025
Lower · Passed
House Committee Favorably Reported By Substitute
lower
Jan 30, 2025
Introduced
House Hopper
lower
6 primary · 0 co-sponsors
Sponsors
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