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HB 810

Insurance; require that final reimbursements to pharmacies for prescription drugs are based on certain formulas

2025-2026 Regular Session Introduced by Michelle Au and 5 co-sponsors

House Bill 810 ensures pharmacies in Georgia receive fair reimbursements for prescriptions, promoting equitable practices and potentially improving patient access to medications.

House Second Readers
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Bill Summary · HB 810

Summary of House Bill 810

Bill Number: HB 810
Title: Insurance; require that final reimbursements to pharmacies for prescription drugs are based on certain formulas
Status: House Second Readers
Introduced: March 20, 2025
Effective Date: July 1, 2025 (with applicability to certain contracts starting October 1, 2025)

Purpose and Intent

House Bill 810 aims to establish a standardized formula for final reimbursements to pharmacies for prescription drugs. The bill seeks to ensure that pharmacies receive fair compensation for the drugs they dispense, thereby promoting equitable practices within the pharmacy benefits management (PBM) system in Georgia.

Key Provisions

  1. Minimum Reimbursement Formula:

    • Pharmacy benefits managers (PBMs) must reimburse pharmacies at least the national average drug acquisition cost (NADAC) for a prescription drug at the time of dispensing, plus a professional dispensing fee of $10.64.
    • If NADAC is unavailable, the reimbursement must be no less than the wholesale acquisition cost (WAC) as defined by federal law, also plus the $10.64 dispensing fee.
    • The professional dispensing fee will adjust annually based on the average percentage change in the Consumer Price Index for medical care.

  2. Exclusion from Effective Rate Guarantees:

    • Reimbursements made under the new formula will not count towards any effective rate guarantees, which are contractual provisions allowing PBMs to adjust reimbursement rates.

  3. Equitable Treatment of Pharmacies:

    • PBMs are prohibited from offering lower reimbursement rates or incentives to non-affiliated pharmacies compared to affiliated pharmacies for the same prescription drug, unless required by law.

  4. Applicability:

    • The provisions do not apply to certain health insurance plans, including those for state employees, public school teachers, and Medicaid when providers are reimbursed directly by the Department of Community Health. However, it does apply to Medicaid care management programs.

  5. Compliance for Care Management Organizations:

    • The Department of Community Health must ensure that contracts with care management organizations for prescription drugs comply with the new reimbursement standards.

Impact

  • Pharmacies: The bill is designed to enhance the financial stability of pharmacies by ensuring they receive fair compensation for the drugs they dispense.
  • Pharmacy Benefits Managers: PBMs will need to adjust their reimbursement practices to comply with the new requirements, potentially impacting their operational models.
  • Patients: By supporting pharmacies, the bill may indirectly benefit patients through improved access to medications and potentially lower costs.

Procedural Timeline

  • March 20, 2025: Bill introduced and entered the House Hopper.
  • March 21, 2025: First reading in the House.
  • March 25, 2025: Bill moved to House Second Readers for further consideration.
  • Effective Date: July 1, 2025, with applicability to relevant contracts starting October 1, 2025.

Conclusion

House Bill 810 represents a significant shift in how pharmacies are reimbursed for prescription drugs in Georgia, aiming to create a more equitable and transparent system. By establishing clear reimbursement formulas, the bill seeks to support pharmacies and ensure fair access to medications for patients.

Compiled from official sources — confirm details with the bill’s official record.

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