2022 Legislation
Georgia’s federal and state lawmakers on both sides of the aisle are working to alleviate how much patients across our community pay at the pharmacy counter for treatments they need.
Many Georgia patients, particularly those living with chronic conditions, need consistent and reliable access to the treatments prescribed by their health care provider to manage symptoms, control their illness, and lead healthier lives. Over 6 million Georgians are living with at least one chronic illness, such as heart disease, HIV, diabetes, or Alzheimer’s.
Powerful health industry middlemen, called pharmacy benefit managers (PBMs), are driving up health care costs and blocking access to lifesaving treatments for many Georgia patients. PBMs work in between health insurers and drug manufacturers to negotiate prescription drug prices and have a significant influence on patients’ ability to access and afford care. PBMs receive significant rebates and discounts from pharmaceutical companies for the cost of medications and treatments, but they don’t pass those savings on to patients receiving the care. This causes Georgians to pay more out of their own pockets for the care they need.
Fortunately, lawmakers are exploring ways to help Georgia patients access the care they need and stop letting PBMs pocket medication discounts that are intended for patients.
FEDERAL LEGISLATION
The bipartisan Pharmacists Fight Back Act (H.R. 9096) aims to protect community pharmacies and ensure they can provide care to patients enrolled in federal health care programs by establishing transparent and fair reimbursement from the PBMs that local pharmacies are often forced to work with.
H.R. 9096 will implement comprehensive PBM reform at the federal level and increase oversight into the predatory practices of these little-known middlemen. To protect Georgia patients and community pharmacies, H.R. 9096 will:
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Restrict PBMs from steering patients toward PBM-owned pharmacies or specific medications;
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Ensure that patients are on the receiving end of negotiated discounts;
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Lower health care costs at the pharmacy counter for Georgia patients; and
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Implement a transparent pharmacy reimbursement model to ensure that independent pharmacies are reimbursed fairly for the medications they purchase to support the patients they serve.
This legislation will reform a system that allows PBMs to improve their bottom lines at the expense of Georgia patients and local, independent pharmacies and ensure patients have reliable and consistent access to their treatment plans.
STATE LEGISLATION
House Bill 343 (HB 343) sought to increase transparency into health insurer and PBM practices and would have required insurers and PBMs to pass 50% of the rebates they receive from drug companies for the cost of medications onto patients.
HB 343 was considered during a hearing held by the Senate Health and Human Services Committee during Georgia’s 2024 legislative session. Despite passionate testimony from patient advocates and Representative Buddy Carter in favor of the legislation, members of the committee voted against the bill 5-8, ultimately ending consideration of HB 343 during this year’s session. Despite this outcome, Rx in Reach remains committed to advocating for policies that will reform harmful PBM practices and ease health care affordability burdens for Georgia patients.
KEY RESOURCES
Check out these resources to learn more about how legislators and other key stakeholders have found that these powerful health industry middlemen are putting treatments out of reach and raising costs:
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Report: House Oversight and Accountability Committee Staff | The Role of Pharmacy Benefit Managers in Prescription Drug Markets
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Report: Federal Trade Commission | Pharmacy Benefit Managers: The Powerful Middlemen Inflating Drug Costs and Squeezing Main Street Pharmacies
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Article: New York Times | The Opaque Industry Secretly Inflating Prices for Prescription Drugs
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Legislation | Protecting Patients Against PBM Abuses Act (H.R.288)