Georgia Pharmacy Anti-Steering and Transparency Act Seeks to Hold PBMs Accountable
Independent retail and specialty pharmacies have long been concerned about perceived “steering” by Pharmacy Benefit Managers (“PBMs”), a practice in which a PBM in some manner channels prescriptions to its own wholly owned retail mail-order or specialty pharmacy. A recent law in Georgia has taken effect to push back against this practice.
Georgia HB 233 (known as the “Pharmacy Anti-Steering and Transparency Act”) was signed into law by Georgia’s Governor in May 2019 along with a companion piece of legislation, Georgia HB 323, both of which are anti-steering bills. The bills went into effect on 1/1/2020. In short, HB 233 (codified at Ga. Code Ann. § 26-4-119) prohibits pharmacies from presenting claims for reimbursement that were received pursuant to a referral from an affiliated PBM. This prohibition applies to pharmacies only, but the bill’s corollary applies to PBMs directly (HB323, codified at Ga. Code Ann. § 33-64-11) and prevents PBMs from forcing patients to get their prescriptions filled at a PBM affiliated pharmacy including specialty pharmacies, with a limited exception regarding certain limited distribution drugs.
This law is a strong policy decision on Georgia’s part to guard patient well-being, patient choice and to protect independent pharmacies in Georgia from PBMs’ anticompetitive practices. Georgians and independent pharmacies should celebrate this accomplishment by its Legislators. However, for this law to have value, pharmacies must be vigilant against PBMs and be willing to fight back when PBMs’ actions violate the law.
How Frier Levitt Can Help
Frier Levitt has extensive experience litigating against PBMs and has represented numerous pharmacies throughout the United States, including in Georgia. Contact Frier Levitt to speak to one of our attorneys about Georgia’s new law and the many other laws in place that protect pharmacies.