08 LC 37
0732S
The
Senate Insurance and Labor Committee offered the following substitute to HB
798:
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 4 of Title 26 of the Official Code of Georgia Annotated, the
"Georgia Pharmacy Practice Act," so as to provide for regulation and licensure
of pharmacy benefits managers by the Commissioner of Insurance; to provide for
definitions; to provide for license requirements and filing fees; to provide for
requirements and procedures affecting pharmacy benefits managers; to provide for
rules and regulations; to provide for related matters; to repeal conflicting
laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Chapter
4 of Title 26 of the Official Code of Georgia Annotated, the "Georgia Pharmacy
Practice Act," is amended by adding a new article to read as
follows:
"ARTICLE
13
26-4-210.
As
used in this article, the term:
(1)
'Business entity' means a corporation, association, partnership, sole
proprietorship, limited liability company, limited liability partnership, or
other legal entity.
(2)
'Commissioner' means the Commissioner of Insurance.
(3)
'Pharmacy benefits manager' means a person, business, or other entity that
performs pharmacy benefits management. The term includes a person or entity
acting for a pharmacy benefits manager in a contractual or employment
relationship in the performance of pharmacy benefits management for a covered
entity. This term shall not include a hospital health system operating a
formulary process or providing a prescription drug program for the benefit of
covered individuals including the hospital health system´s employees and
their dependents.
26-4-211.
(a)
No business entity shall act as or hold itself out to be a pharmacy benefits
manager in this state, other than an applicant licensed in this state for the
kinds of business for which it is acting as a pharmacy benefits manager, unless
such business entity holds a license as a pharmacy benefits manager issued by
the Commissioner. The license shall be renewed on an annual basis and in such
manner as the Commissioner may prescribe by rule or regulation. Failure to hold
such license shall subject the pharmacy benefits manager to the fines and other
appropriate penalties as provided in Chapter 2 of Title 33.
(b)
An application for a pharmacy benefits manager´s license or an application
for renewal of such license shall be accompanied by a filing fee to be
prescribed by rule or regulation of the Commissioner.
(c)
A license may be refused or a license duly issued may be suspended or revoked or
the renewal of such license refused by the Commissioner if the Commissioner
finds that the applicant for or holder of the license:
(1)
Has intentionally misrepresented or concealed any material fact in the
application for the license;
(2)
Has obtained or attempted to obtain the license by misrepresentation,
concealment, or other fraud;
(3)
Has misappropriated, converted to his or her own use, or illegally withheld
money belonging to an insurer or an insured or beneficiary;
(4)
Has committed fraudulent or dishonest practices;
(5)
Has materially misrepresented the terms and conditions of insurance policies or
contracts;
(6)
Has failed to comply with or has violated any proper order, rule, or regulation
issued by the Commissioner;
(7)
Is not in good faith carrying on business as a pharmacy benefits
manager;
(8)
Has failed to obtain for initial licensure or retain for annual renewal an
adequate net worth as prescribed by order, rule, or regulation of the
Commissioner; or
(9)
Has shown lack of trustworthiness or lack of competence to act as a pharmacy
benefits manager.
(d)
If the Commissioner moves to suspend, revoke, or nonrenew a license for a
pharmacy benefits manager, the Commissioner shall provide notice of that action
to the pharmacy benefits manager and the pharmacy benefits manager may invoke
the right to an administrative hearing in accordance with Chapter 2 of Title
33.
(e)
No licensee whose license has been revoked as prescribed under this Code section
shall be entitled to file another application for a license within five years
from the effective date of the revocation or, if judicial review of such
revocation is sought, within five years from the date of final court order or
decree affirming the revocation. The application when filed may be refused by
the Commissioner unless the applicant shows good cause why the revocation of its
license shall not be deemed a bar to the issuance of a new license.
(f)
Appeal from any order or decision of the Commissioner made pursuant to this
article shall be taken as provided in Chapter 2 of Title 33.
(g)(1)
The Commissioner shall have the authority to issue a probationary license to any
applicant under this article.
(2)
A probationary license may be issued for a period of not less than three months
and not longer than 12 months and shall be subject to immediate revocation for
cause at any time without a hearing.
(3)
The Commissioner, at his or her discretion, shall prescribe the terms of
probation, may extend the probationary period, or refuse to grant a license at
the end of any probationary period.
(h)
A pharmacy benefits manager´s license may not be sold or transferred to a
nonaffiliated or otherwise unrelated party. A pharmacy benefits manager may not
contract or subcontract any of its negotiated services to any unlicensed
business entity unless a special authorization is approved by the Commissioner
prior to entering into a contracted or subcontracted arrangement.
(i)
The Commissioner may, at his or her discretion, assess a penalty or a fine
against any business entity acting as a pharmacy benefits manager without a
license for each transaction in violation of this chapter.
(j)
A licensed pharmacy benefits manager is not permitted to market or administer
any insurance product not approved in Georgia or that is issued by a nonadmitted
insurer or unauthorized multiple employer self-insured health plan.
26-4-212.
The
Commissioner may promulgate rules and regulations which are necessary to
implement the provisions of this article and to ensure the safe and proper
operation of pharmacy benefits managers of this state."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.