Will New PBM Reforms Lower Drug Prices in Georgia?
Pharmacy Benefit Managers (PBMs) are companies that help insurance plans manage prescription drug benefits. They decide which medications are covered, negotiate prices with drug manufacturers, and set payment rates for pharmacies. While PBMs can lower drug costs by getting discounts from drug makers and pharmacies, they also have significant control over medication pricing, patient access, and pharmacy reimbursements. Critics argue that PBMs’ business practices can drive up costs for consumers and independent pharmacies, while supporters believe they help manage drug spending and ensure affordability. Additionally, PBMs are often owned by an insurer or pharmacy, meaning these PBMs are managed by the same stakeholders that set drug prices for consumers.
This year, Georgia lawmakers have introduced three bills to regulate PBMs: HB 196, SB 60, and SB 91. Introducing multiple bills on PBMs shows their practices are a major concern for legislators, pharmacies, and consumers. HB 196 requires PBMs to pay independent pharmacies based on certain national or state average payment rates, which could help keep more local, independent pharmacies open. SB 60 would require PBMs to act in the best interests of patients, health care providers, and health plans when making decisions about drug coverage. SB 91 would increase transparency by requiring PBMs to report pricing and rebate details to the Georgia Department of Insurance.
If passed, these bills could change how PBMs operate in health plans regulated by Georgia (individual, group, Medicaid, and State Health Benefit Plan health insurance) and impact how much people pay for medications. The bills could also affect which pharmacies stay in business and how easily patients can get the prescriptions they need. Supporters of these bills believe stronger rules will help patients and small pharmacies by making drug pricing fairer and more transparent. Opponents argue that over-regulating PBMs could raise overall drug costs or reduce the discounts that PBMs negotiate. These bills are part of a larger discussion about how to balance affordability, fairness, and access to prescription drugs.
Two bills move forward that would limit evidence-based health care for transgender adults and youth
Sponsored by Sen. Ben Watson, SB 30 was heard and passed by the Senate Health & Human Services committee last Thursday. The bill would prohibit hospitals (and the providers working in hospitals) from prescribing or administering medicines that delay or suppress puberty (often called “puberty blockers”) to minors. SB 30 goes farther than the 2023 law (SB 140 from that year) that banned other types of gender-affirming care for youth in Georgia.
SB 30 will now go to the Senate Rules Committee, where it is likely to move to the full Senate for a vote.
The Georgia Senate approved SB 39 last Tuesday. This legislation would prohibit Medicaid, the state health benefit plan, and any state-funded providers from covering necessary care for transgender Georgians—both youth and adults. Among the Georgians impacted by this legislation are adults who choose to work in public service jobs (often making less money than they could in the private sector); these hard-working Georgians will have to go without gender-affirming care that their doctors and they agree is appropriate for them, or pay for it out of pocket. This type of legislation threatens access to essential health care and could have hurtful and dangerous consequences for transgender folks across the state.
After the Senate’s approval, SB 39 has now moved to the House. It has been referred to the House Health Committee.
Pathways has failed to expand care, leaving hundreds of thousands of Georgians without coverage. Even with proposed changes, it still creates unnecessary barriers for low-income workers, caregivers, and those with health challenges.
Take action now: Click here to submit a public comment via email. Demand real policy change that removes restrictions and provides coverage to those who need it most.
Legislation on Our Radar
SENATE BILLS
SB 30 – Ban on Gender-Affirming Medical Care for Minors
Lead Sponsor:Sen. Watson (District 1)
What this bill does:
Senate Bill 30 would expand Georgia’s restrictions on gender-affirming medical care for minors by banning puberty blockers, hormone therapy, and gender-affirming surgeries. It goes further than the existing SB 140 law from 2023 by removing exceptions, increasing penalties for doctors, and allowing parents to sue medical providers.
Key Details:
What treatments are banned?
Puberty blockers – Medications that delay the physical changes of puberty. (Previously allowed under SB 140)
Hormone therapy – Prescribing estrogen or testosterone to align a minor’s physical traits with their gender identity. (Now completely banned, even for minors already receiving treatment)
Gender-affirming surgeries – such as removal or reconstruction of sex organs for treatment of gender dysphoria
Any medical intervention that seeks to change a minor’s biological sex characteristics for gender transition.
Who does this apply to?
All medical providers in Georgia, including doctors, hospitals, and clinics.
Any minor (under 18 years old) seeking gender-affirming medical care.
Are there any exceptions?
YES – The law does not apply to minors receiving treatment for:
Medical conditions unrelated to gender dysphoria that require hormone therapy (such as early puberty or hormone deficiencies).
Individuals born with intersex conditions or chromosomal abnormalities affecting sex development.
Individuals with partial androgen insensitivity syndrome (a genetic condition affecting hormone response).
How is SB 30 different from SB 140 (2023)?
SB 140 (2023 Law)
SB 30 (2025 Proposal)
Puberty Blockers
Allowed for minors
Banned for minors
Hormone Therapy
Banned except if started before July 1, 2023
Banned for all minors
Gender-Affirming Surgery
Banned for minors
Same ban as SB 140
Legal Liability for Providers
Only professional discipline
Doctors and hospitals can be sued by parents
Potential Impact:
Expands restrictions on gender-affirming care for minors, going beyond SB 140.
Provides legal recourse for parents who do not consent to gender-affirming medical care for their child.
Removes all gender-affirming medical options for minors, including treatments previously allowed under SB 140.
Could discourage healthcare providers from treating transgender patients, even for unrelated medical needs.
May face legal challenges, as courts in other states have blocked similar laws banning puberty blockers.
SB 130 – Medical School Loan Forgiveness and Graduate Medical Education Expansion
Lead Sponsor:Sen. Hodges (District 3)
What this bill does:
Senate Bill 130 expands medical education funding and Georgia’s service cancelable loan program to help increase the number of doctors, dentists, physician assistants, and advanced practice nurses in underserved rural areas. The bill broadens eligibility for state-funded medical education payments and adds medical residents and fellows to Georgia’s service cancelable loan program.
Key Details:
Expanded Medical Education Funding
Hospitals and medical facilities can receive state funding if they:
Offer Accreditation Council for Graduate Medical Education (ACGME) approved residency or fellowship programs.
Operate as a Medicare-certified medical facility that trains healthcare professionals.
State payments for medical training:
The Department of Community Health will pay up to $10,000 per year for each resident or fellow trained in an eligible hospital or facility.
Funding will be limited based on available state funds and adjusted if the budget is short.
Expansion of Georgia’s Service Cancelable Loan Program to include:
Medical residents and fellows in ACGME-accredited training programs.
Fourth-year dental students in accredited U.S. dental schools.
How the loan forgiveness program works:
Medical professionals receive state-funded loans to pay for their training.
Loans can be forgiven (canceled) if the recipient agrees to work in a rural or medically underserved area of Georgia after training.
Priority will be given to candidates who agree to work in high-need areas.
Who qualifies?
U.S. citizens in approved graduate medical education programs.
Must be licensed to practice in Georgia (except for students still in training).
Potential Impact:
Increases the number of doctors, dentists, and other healthcare providers in rural and underserved areas.
Expands financial aid options for medical trainees, reducing student debt.
Encourages more hospitals to offer residency and fellowship programs, strengthening Georgia’s medical training system.
Funding is limited, meaning not all eligible trainees may receive financial support.
Some graduates may not stay in rural areas long-term, reducing the program’s effectiveness in improving long-term healthcare access.
SB 142 – International Medical Graduate Licensing Reform
Lead Sponsor:Sen. Jackson (District 41)
What this bill does:
Senate Bill 142 creates a new pathway for international medical graduates (IMGs) to become licensed physicians in Georgia. The bill establishes provisional, limited, and full medical licenses for doctors who received their medical education outside the United States, allowing them to practice in underserved areas or teach at medical schools.
Key Details:
Who Qualifies for a Provisional Medical License?
The applicant must be an international medical graduate (IMG) with a medical degree from an accredited school outside the U.S.
The IMG must have practiced medicine for at least three of the past ten years.
The IMG must pass Step 1 and Step 2 of the United States Medical Licensing Examination (USMLE).
The applicant must secure full-time employment at an approved hospital, clinic, or medical school in Georgia.
The Georgia Composite Medical Board may waive certain credentialing requirements if an IMG is unable to obtain documents due to political or administrative barriers in their home country.
A provisional license is valid for up to two years and cannot be renewed.
How Can an IMG Get a Limited License?
After holding a provisional license for two years, the IMG must:
Pass Step 3 of the USMLE.
Enter a full-time employment contract to practice in a health professional shortage area, medically underserved area, or population, or teach at a Georgia medical college or affiliated clinic.
A limited license is valid for up to two years and can be renewed.
How Can an IMG Obtain a Full Medical License?
After holding a limited license for at least two years, an IMG may apply for full licensure if they:
Have met all the requirements of the provisional and limited licenses.
Have maintained a good standing with the Georgia Composite Medical Board.
Other Key Provisions:
The Georgia Composite Medical Board will oversee and enforce licensing rules.
Licenses can be denied or revoked if an IMG fails to comply with state medical regulations.
Hospitals or clinics employing IMGs must carry medical malpractice insurance for them.
The Georgia Department of Community Health and the Georgia Board of Health Care Workforce will help place IMGs in underserved areas.
Potential Impact:
Some IMGs may face visa-related challenges, as they must have a legal immigration status that allows them to work as physicians.
Expands the number of qualified doctors in Georgia, particularly in rural and underserved areas.
Helps address Georgia’s physician shortage by creating a structured pathway for foreign-trained doctors to practice.
Provides flexibility for IMGs facing documentation challenges, allowing them to apply without certain records if their home country is uncooperative.
Potential concerns about training differences, as IMGs may not have completed U.S. residency programs.
Requires oversight to ensure patient safety, as doctors will be practicing without completing a U.S. residency.
HOUSE BILLS
HB 341 – Tax Credit for Individual Coverage Health Reimbursement Arrangements (ICHRA)
Lead Sponsor:Rep. Newton (District 127)
What this bill does:
HB 341 would create a state tax credit for small businesses (100 or fewer employees) that offer Individual Coverage Health Reimbursement Arrangements (ICHRAs) to their employees. The goal is to encourage more small employers to help workers afford private health insurance.
What is an Individual Coverage Health Reimbursement Arrangement (ICHRA)?
An Individual Coverage Health Reimbursement Arrangement (ICHRA) is a way for employers to help their employees pay for health insurance. Instead of offering a traditional health insurance plan, the employer gives employees tax-free money to buy their own individual health insurance plan or cover other medical expenses.
How an ICHRA Works:
Employer sets a monthly allowance – The company decides how much money they will give each employee every month to help pay for health insurance.
Employee buys their own plan – Employees can shop for their own health insurance on the marketplace (like Healthcare.gov) or from private insurers.
Employee submits proof of purchase – The employee pays for their insurance and shows proof to their employer (like a receipt).
Employer reimburses the employee – The company pays back the employee up to the amount allowed in the ICHRA.
Key Details of HB 341:
Who qualifies for the tax credit? Employers with 100 or fewer employees.
Employers who offer ICHRA contributions of at least $100 per month per employee.
Employers whose ICHRA contributions are equal to or greater than what they contributed to employee health benefits the previous year.
How much is the tax credit? The credit starts at $600 per employee per year for the first three years.
It drops to $400 per employee in year four and $200 per employee in year five.
Employers can claim the credit for a maximum of five years.
Statewide Tax Credit Cap:
$5 million in total credits will be available in 2026.
This cap increases by $5 million each year if the prior year’s limit was reached.
How do employers apply? Employers must apply for preapproval from the Georgia Department of Revenue.
Potential Impact:
Encourages more small businesses to offer financial support for employee health insurance.
Gives employees more flexibility to choose their health plans instead of being limited to employer-provided group plans.
Could help reduce the number of uninsured workers in Georgia.
Employers must front the cost of ICHRA contributions, and the tax credit won’t be received until the following tax year.
Limited availability—employers may not receive the credit if the statewide cap is reached.
ICHRA plans do not guarantee affordability—some employees may struggle to afford private coverage even with the reimbursement.
HB 420 – Insurance Coverage for Genetic Testing and Cancer Imaging
Lead Sponsor:Rep. Taylor (District 173)
What this bill does:
HB 420 would require health insurance plans to cover genetic testing for inherited mutations and cancer imaging for patients who are at an increased risk of cancer. The bill ensures that eligible patients receive these services without cost-sharing (such as deductibles, copays, or coinsurance), making these screenings more accessible.
Key Details:
Who is covered?
Patients with a personal or family history of cancer when genetic testing is recommended by a doctor.
Patients at increased risk of cancer who need additional cancer imaging beyond routine screenings.
What services must insurance cover?
Genetic testing for inherited mutations (such as BRCA1/BRCA2) to assess cancer risk.
Cancer imaging (such as MRIs, CT scans, and ultrasounds) for high-risk patients.
Requirements for insurance coverage:
Testing and imaging must be:
Clinically useful, meaning they help guide treatment decisions.
Recommended by a doctor.
In line with nationally recognized clinical guidelines (such as those from the National Comprehensive Cancer Network).
Cost-sharing protections:
No deductibles, copays, or coinsurance—patients won’t have to pay out-of-pocket for these services.
Coverage cannot replace or reduce other benefits included in the health plan.
Health Savings Accounts (HSAs):
If removing cost-sharing would make a high-deductible health plan ineligible for HSA contributions, the requirement would only apply after the deductible is met.
State Oversight:
The Georgia Insurance Commissioner will issue rules to ensure compliance with medical guidelines.
Potential Impact:
Increases access to genetic testing and cancer screening for at-risk patients.
Reduces financial barriers for cancer detection and prevention.
Helps doctors identify high-risk patients earlier, potentially leading to earlier cancer diagnoses and better outcomes.
Could raise insurance premiums, as insurers would cover more services without cost-sharing.
May require insurance companies to adjust policies, which could create short-term administrative challenges.
HB 422 – High Deductible Health Plans in the State Health Benefit Plan
Lead Sponsor:Rep. McCollum (District 30)
What this bill does:
House Bill 422 would require Georgia’s State Health Benefit Plan (SHBP) to offer at least two high-deductible health plan (HDHP) options to employees. The bill also ensures that state employees enrolled in these plans can make pre-tax contributions to Health Savings Accounts (HSAs) through payroll deductions.
Key Details:
Who is affected?
State employees and public school employees enrolled in Georgia’s SHBP.
Employees of local boards of education and other government entities that participate in SHBP.
What does the bill require?
By October 1, 2025, SHBP must offer at least two HDHP options from different insurance providers.
Each HDHP must be compatible with an HSA, meaning it meets the federal definition under Section 223 of the U.S. Internal Revenue Code.
State employees enrolled in an HDHP must be able to make pre-tax payroll contributions to an HSA.
What about employees in local governments or school systems?
The bill encourages other government entities (such as school districts) that participate in SHBP to also allow pre-tax payroll deductions for HSAs.
Potential Impact:
Gives state employees more health plan choices by ensuring HDHP options are available.
Expands access to Health Savings Accounts (HSAs), allowing employees to save for health care costs on a tax-free basis.
Encourages cost-conscious health care decisions, as HDHPs generally have lower premiums but higher deductibles.
May increase out-of-pocket costs for employees who enroll in HDHPs but do not contribute to an HSA.
Advocate With Us At The Capitol!
Join These Advocacy Events During the Legislative Session
Each week during the legislative session, we’ll highlight legislative advocacy days hosted by our partner organizations. These events offer excellent opportunities for you to engage in the lawmaking process by meeting your legislators and advocating for critical health issues.
Here are the upcoming events:
February 19 – Mental Health Parity Day, hosted by The Carter Center, Georgians for a Healthy Future, and the Georgia Parity Collaborative
Please contact Anthony Hill at ahill@healthyfuturega.org if you have an advocacy event you’d like included in GHF’s legislative update
We hope to see you at one or more of these impactful events!
Join Cover Georgia for Advocacy Day – February 24!
The fight for health care access doesn’t end with Pathways. On Monday, February 24, 2025, Cover Georgia is bringing together advocates from across the state for Advocacy Day at the Capitol.
This is your opportunity to:
Call on state leaders to take action on the coverage gap.
Share personal stories that highlight why health care access matters.
Stand in solidarity with other advocates fighting for Medicaid expansion.
Not sure what to say? Our Advocacy Day Toolkit has everything you need, including:
GHF monitors legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, here are tools to help you stay in touch with health policy under the Gold Dome.
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