O.C.G.A.
O.C.G.A.

O.C.G.A. § 33-64-4 (2019)

(For effective date, see note.) Pharmacy benefits manager shall not engage in the practice of medicine; recommended use of licensed physician

✓ O.C.G.A. (archive.org 2024 item): print volumes of 2004-2024, per-volume vintage; older volumes partly replaced by 2019 Release 73 text; no 2025 or 2026 Acts
Code text and O.C.G.A. statutory annotations on this page reflect the 2019 Official Code of Georgia Annotated (Public.Resource.Org Release 73, 2019-08-21; public domain per Georgia v. Public.Resource.Org, 2020). The Syfert case-law annotations in Notes of Decisions, below, are current.
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(a) No pharmacy benefits manager shall engage in the practice of medicine, except as otherwise provided in subsection (b) of this Code section.

(b) Any physician employed by or contracted with a pharmacy benefits manager advising on or making determinations specific to a Georgia insured in connection with a prior authorization or step therapy appeal or determination review shall:

(1) Have actively seen patients within the past five years; and

(2) Have practiced in the same specialty area for which he or she is providing advisement within the past five years.

(c) For contracts and amendments entered into with a pharmacy benefits manager on and after July 1, 2021, the department is encouraged to require the use of a licensed Georgia physician for prior authorization or step therapy appeal or determination reviews.

History

Code 1981, § 33-64-4, enacted by Ga. L. 2010, p. 757, § 1/SB 310; Ga. L. 2020, p. 768, § 3/HB 946; Ga. L. 2020, p. 780, § 3/SB 313. Delayed effective date. - This Code section, as set out above, becomes effective July 1, 2021. For version of this Code section in effect until July 1, 2021, see the 2020 amendment note. The 2020 amendments. - The first 2020 amendment, effective July 1, 2021, designated the existing provisions as subsection (a); added ‘‘, except as otherwise provided in subsection (b) of this Code section’’ at the end of subsection (a); and added subsections (b) and (c). The second

2020 amendment, effective July 1, 2021, made identical changes. See the Editor’s notes for applicability.

Annotations

Code Commission notes. - Pursuant to Code Section 28-9-5, in 2020, ‘‘July 1, 2021’’ was substituted for ‘‘the effective date of this Act’’ in the middle of subsection (c). Editor’s notes. - Ga. L. 2020, p. 768, § 9(a)/HB 946 and Ga. L. 2020, p. 780, § 9(a)/SB 313, not codified by the General Assembly, provide, in part, that the amendment by that Act shall apply to all contracts issued, delivered, or issued for delivery in this state on and after July 1, 2021.