Lawmakers address budget, PBMs, network pay & tort reform
The Georgia House of Representatives and Senate spent much of the week in hearings to address the state budget.
In terms of legislation, the Senate Insurance and Labor Committee held full committee and subcommittee hearings on a bill (S.B. 313) by Sen. Dean Burke, M.D. (R-Bainbridge) that would address pharmacy benefit managers (PBMs) practices – such as “steering” (i.e., forcing patients to use PBM-owned pharmacies) and pharmaceutical manufacturers’ rebates. This measure includes language from a MAG 2019 House of Delegates resolution that calls for physicians to be involved with prior authorization and step therapy determinations, formulary development, and formulary management. These physicians would have to be licensed in Georgia, currently seeing patients, and focused on the disease or condition for which they’re providing advice. S.B. 313 would also require PBMs to file reports with the Georgia Composite Medical Board and the Georgia Board of Pharmacy when a prior authorization requirement delays a patient’s care and results in an adverse outcome. MAG testified in support of this bill, which remains in the aforementioned subcommittee.
The Senate Health and Human Services Committee held a hearing on a bill (S.B. 359) by Sen. Chuck Hufstetler (R-Rome) that would 1) set the price that should be paid for out-of-network emergency care and unanticipated out-of-network non-emergency care at the 2017 median contracted rate, adjusted annually according to the Consumer Price Index (CPI), and paid without the need for prior authorization and without any retrospective payment denials and 2) allow a patient to choose out-of-network elective care by consenting in writing and orally at least 48 hours in advance with an estimate of the charges and 3) require an insurer to use the most recent in-network contract rates as the initial payment for a physician/provider when a contract is terminated without cause by the insurer or with cause by a physician/provider within one year of the effective date of the legislation and 4) establish a “baseball-style” arbitration system (i.e., the insurer and physician/provider would each submit a payment amount and an arbitrator would choose one of the numbers and the “loser” would pay the arbitration costs and the bundling or batching of claims would be allowed, with no thresholds).
MAG Government Relations Director Derek Norton reports that, “In our testimony before the committee, we said that MAG is encouraged by many of the changes that have been made to the legislation, but we remain concerned about the reliability of the data that would be used to establish the initial payment and provisions related to non-emergency care. MAG will continue to work with the bill’s sponsors and other stakeholders to enhance this legislation.”
MAG is also addressing an identical bill that has been introduced in the House, H.B. 888.
Finally, Sen. John Kennedy (R-Macon) introduced a bill (S.B. 374) that would limit the scope of what can be included in offer and acceptance demands by plaintiffs in lawsuits. This legislation is part of a larger push to reform the state’s tort environment by MAG and a broad stakeholder coalition. S.B. 374 has not yet been assigned to a committee.
