Members of the House Majority Caucus announced their plan to introduce legislation during the 2020 legislative session that seeks to return health care dollars and day-to-day health care decisions to patients and health care professionals in Georgia. The caucus announced its legislative plan after the House Special Committee on Access to Quality Health Care meeting on Tuesday, January 7, 2020.

“Today, we heard from patients and providers about opaque practices of PBMs and managed care organizations that increased costs to patients and taxpayers and, more importantly, compromise the health of Georgians,” said Majority Caucus Chairman Matt Hatchett (R-Dublin). “We are committed to bringing a stop to these practices.”

“Wall Street is bleeding us of money and choices, and we are going to take both of those back,” said State Representative David Knight (R-Griffin). “This money and decision-making power has been shipped by massive health care companies to Wall Street, where it has enriched investors, while hurting those who need care across Georgia.”

The proposed legislation, which will be spearheaded by Rep. Knight, aims to bring transparency to the prescription drug market, while at the same time, closing loopholes in existing laws that managed care organizations (MCOs), pharmacy benefits managers (PBMs) and state contracted PBMs use to continue to engage in practices that may harm patients. Additionally, the new legislation would carve out of prescription drug benefits from Medicaid managed care. The legislation was in part inspired by actuarial study by the state of West Virginia that showed the carve out saved over $50 million, while paying community pharmacies fairly at the same time. Finally, the legislation would bring true oversight to PBMs and MCOs that contract and subcontract with the state.

This legislative plan builds upon House Bill 233, or the “Pharmacy Anti-Steering and Transparency Act,” which was passed during the 2019 legislative session and enacted January 1, 2020. HB 233 prohibits pharmacies owned by PBM and insurance affiliates from poaching patient information for profit or non-patient care purposes. It also prohibits pharmacies from receiving self-dealing referrals from their affiliates and billing to the Board of Pharmacy, tasks the Board of Pharmacy with enforcement authority for violations of the law and requires pharmacies to disclose affiliates.

“Lowering costs, empowering patients and improving outcomes are the holy grails of health care legislation,” said House Speaker David Ralston (R-Blue Ridge). “We are going to significantly advance all three of those goals with this legislation in 2020.”