Archives: Bills

HB 196 would require greater transparency and set standards for how Georgia’s State Health Benefit Plan (SHBP) reimburses pharmacies for prescription drugs. The bill establishes new rules for how pharmacy benefits managers (PBMs) and insurers must calculate drug reimbursements to ensure that pharmacies receive fair payment for dispensing medications. The Senate committee voted on an updated version of HB 196, which removed the ability for a pharmacy or beneficiary to sue the PBM if they violate the reimbursement guidelines outlined in the bill, including by adjusting the final price with a prescription drug discount card.

What HB 506 does: (Note: HB 506 was a bill related to Medicaid reimbursement for tobacco cessation. However, the Senate removed the original language and replaced it with SB 462, which was the Senate’s ground ambulance surprise billing bill.) Extends Georgia’s surprise billing protections to emergency ground ambulance transportation. HB 506 would cap what patients pay for out-of-network ambulance rides at the same amount they’d pay for in-network rides, and prohibit ambulance companies from billing patients for the rest. The bill sets a minimum payment rate for ambulance companies at the locally negotiated rate, or, if none exists, at the lesser of 325% of Medicare rates or the billed charges.

Consumer impact: Georgians currently face unexpected ambulance bills ranging from hundreds to thousands of dollars, even with insurance. HB 506 would close that gap in Georgia’s surprise billing law.

Senate Bill 276 strengthens accountability for third-party payers(such as private insurance companies and pharmacy benefit managers) when paying health care costs for Medicaid beneficiaries. The bill requires these payers to respond promptly to claims and inquiries and prohibits denials of payment based on prior authorization issues.

SB 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 some exceptions, increasing penalties for doctors, and allowing parents to sue medical providers. The substitute permits the use of blockers, if approved ahead of time by two psychiatrists or psychologists and under the care of a pediatrician certified in the condition or board-certified. The new language makes it very difficult for a minor currently receiving puberty blocker treatment to continue, but does not fully prohibit it.

SB 72, also known as the “Hope for Georgia Patients Act,” expands access to investigational treatments for patients with severely debilitating or life-threatening illnesses. The bill builds on Georgia’s existing Right to Try Act by allowing patients to seek personalized, experimental medical treatments not fully approved by the U.S. Food & Drug Administration (FDA). While the bill could expand access to experimental treatments for patients with rare or terminal diseases, it also opens the door to further expansion of access to treatments not approved by the FDA. FDA approval ensures that drugs meet strict safety and efficacy standards, and bypassing this process could expose patients to unknown risks. Additionally, patients may pursue costly, unproven treatments that may not work or could worsen their condition.

HB 197 strengthens the review requirements for health insurers and utilization review entities when they question whether a medical treatment is necessary. The bill ensures that treating health care providers have a fair chance to discuss their treatment decisions with an appropriately trained clinical peer before an insurance company or review entity makes an adverse determination (a decision that denies or limits coverage for treatment).

SB 131 would create a parity compliance review panel within the Behavioral Health Coordinating Council to identify and address mental health parity violations by health insurers and state health care entities. The bill adds the Insurance Commissioner to the Coordinating Council and requires health care providers to report suspected parity violations to the panel using forms and processes the panel establishes. The panel would evaluate these reports, determine whether violations occurred, and recommend punitive actions to the Commissioner of Insurance (for private insurers) and the Commissioner of Community Health (for state-run insurance programs like Medicaid).

What SB 195 does: SB 195 would allow pharmacists in Georgia to dispense Pre-Exposure Prophylaxis (PrEP) for HIV prevention without a prescription from a doctor. PrEP is a highly effective medication that reduces the risk of HIV transmission by up to 99% when taken as prescribed. However, barriers to accessing PrEP such as requiring a doctor’s prescription, lack of insurance, or stigma can prevent people at risk from getting preventive treatment. Expanding access through pharmacies allows individuals to obtain PrEP more quickly and conveniently, particularly in areas with limited health care providers. The bill establishes guidelines for pharmacists to provide PrEP under a statewide protocol, thereby increasing access to the medication.

What HB 291 does: HB 291 would establish a certification process for community health workers (CHWs) in Georgia. CHWs are frontline public health workers who help connect individuals to health care and essential services, particularly in underserved communities. They go by many titles, such as Patient Navigator, Community Health Advocate, and Promotora de Salud. By setting uniform standards and training for CHWs, creating a statewide certification system would support a skilled, stable CHW workforce.

SB 39 would prohibit the use of state funds to cover gender-affirming care, including hormone therapy and sex reassignment surgery, for individuals enrolled in state-funded health plans or receiving public assistance. The bill also bans state-owned health care facilities and state-employed providers from offering gender-affirming care.