Week 7 of Georgia’s legislative session (February 24-28 and days 17-21) saw continued attention on legislation related to the practices of PBMs both through committee hearings and committee votes on previously introduced legislation as well as new legislation introduced.

HB 918; HB 946; and HB 947

HB 918 (Rep. Sharon Cooper’s bill updating the Pharmacy Audit Bill of Rights and strengthen the Pharmacy Anti-Steering Act) and Rep. Knight’s HB 946 (PBM legislation) and HB 947 (Actuarial study & Medicaid cave out) were all heard by the House Special Committee on Access to Quality Healthcare on Thursday, the 27th. While it was originally scheduled to be a two-hour hearing, Chairman Newton allowed the hearing to continue to ensure that pharmacists and other patient advocates had the opportunity to be speak and be heard. Please reach out to Chairman Newton and thank him for ensuring that pharmacists were heard.

In explaining his legislation, Rep. Knight delivered a hard hitting and methodical presentation including outlining examples of PBM steering and issues in Medicaid managed care. On HB 918, Rep. Cooper delivered an impassioned speech on the ills of patient steering and abusive audit practices.

The Committee also heard from an array of others on the negative impact on patient care including the Medical Association of Georgia, the National Multiple Sclerosis Society, and the Rx in Reach Coalition. Georgia Pharmacists Thomas Jusu, Chelley Williams, and Kevin Woody also presented moving and compelling testimony in support of the legislation.

Friday morning the committee voted on and passed all three bills out of Committee. Next stop is the Rules Committee and then the House floor.

At the same time as the House Special Committee on Access to Quality Healthcare meeting Friday morning, the Senate Insurance and Labor subcommittee voted in favor of SB 313 and it now goes to the full committee for a vote. Subcommittee Chair Larry Walker and Senator Freddie Sims Powell voted in favor of SB 313. Please reach out and thank them for their support.

Legislation Introduced in Week 7

HB 991

Introduced by Representative Hatchett, HB 991 looks to put an end to opaque practices and lack of transparency by CMOs, PBMs, and others contracted with state plans by bringing true transparency and oversight by creating the Healthcare Transparency and Accountability Oversight Committee which will have the authority to review conduct and performance of state health care plan contractors. GPhA is strongly in support of this legislation.

HB 1027

Introduced by Rep. Hawkins, this bill looks to require PBMs to pass at least 80% of rebates received or to be received on to patients at the point of sale via reduction of a patients cost share amount. of rebates it receives to patients at the point of sale. The state and Medicaid managed care would be carved out this requirement.

SB 427

Introduced by Senator Mullis, HB 427 is a companion bill to HB 947 and looks to task an actuarial study of savings to the state by carving prescription drugs out of Medicaid managed care and having those benefits administered in Georgia’s Medicaid fee for service program. If the study reflects savings of $20 million or more DCH will proceed with a carve out to implemented by July of 2021. If the savings are between $10 million and $20 million DCH is authorized to proceed. Please reach out to Senator Mullis and thank him for bringing this important piece of legislation and for being such a staunch supporter of pharmacists and their patients.

SB 433

Introduced by Senator Jones, this bill seeks to bring transparency to the prescription drugs treating diabetes. Specifically, this bill contains reporting requirements for insulin drug manufacturers, pharmacy benefits managers, and pharmacists. GPhA is supportive of efforts at transparency and will look to engage and monitor.

Other Previously Introduced Legislation

HB 888, Rep. Hawkins’ surprise billing legislation, was favorably reported by the House Special Committee on Access to Care.

HB 952 which looks to restrict corporations that own multiple pharmacies from implementing corporate policies and procedures that restrict the quantity of controlled substances was favorably reported by the House Special Committee on Access to Quality Healthcare.

SB 303, providing for greater transparency of prices for nonemergency health care services, passed the Senate and makes its way to the House.

SB 321, Sen. Burke’s online provider legislation, was favorably reported by the Senate Insurance & Labor Committee and passed by the Senate. It now goes to the House for Consideration.

SB 359, Sen. Hustetler’s surprise billing legislation, was favorably reported by Senate HHS and passed on the House floor.

Week 6 of Georgia’s legislative session (days 14-17) proved to be a busy one for pharmacy with several exciting pieces of pro-patient and pro-pharmacy legislation being introduced with an exciting array of bill sponsors and cosponsors.

HB 918: Strengthening existing PBM laws

Introduced by Rep. Sharon Cooper, this strengthens Georgia’s Pharmacy Audit Bill of Rights and strengthen the Pharmacy Anti-Steering Act passed into law last year via HB 233. Specifically, this bill looks to:

• Remove language in the law being relied upon by DCH to allow steering in the state health benefit plan;
• Update the audit bill of rights to increase Commissioner of Insurance authority and limit PBM recoupments from pharmacies to situations when there has been fraud; a mis-fill; or an overpayment; and
• Strengthen Georgia’s anti-steering law by prohibiting PBMs from steering via monetary penalties including withholding coverage; prohibiting PBM to PBM pharmacy referral arrangements; and apply steering protections to patients who receive limited distribution drugs and to patients in Medicaid managed care.

This is a critical piece of legislation for pharmacy patients which GPhA will advocate hard for.

HB 946: Mandating PBM Pricing reports 

Rep. Knight’s HB 946 is a companion bill to SB 313 and it HB 946 looks to bring true transparency to prescription drug pricing in Georgia by

• mandating PBMs report deviations in connection with public pricing benchmarks,
• prohibiting spread pricing and retroactive recoupments, and
• requiring rebates to be passed back to payors.

It also seeks to protect patients by prohibiting practices including withholding coverage for lower cost generic drugs; failing to count copay assistance towards deductibles; and removing a drug from a formulary for the purpose of pushing patients to a different plan.

Finally, this bill looks to protect patient choice by strengthening anti-steering law, and imposing a first in the nation surcharge on PBMs and their insurer clients when they engage in the practice of patient steering to affiliated pharmacies.

HB 947: Studying a Prescription drug carve-out

Introduced by Rep. Knight, HB 947 sets forth some of the many problems in prescription drug administration in Georgia’s Medicaid managed care program including poor outcomes, self dealing, and high administrative costs. This bill looks to tackle these problems by tasking an actuarial study of savings to the state by carving prescription drugs out of Medicaid managed care and having those benefits administered in Georgia’s Medicaid fee for service program. If the study reflects savings of $20 million or more DCH will proceed with a carve out to implemented by July of 2021. If the savings are between $10 million and $20 million DCH is authorized to proceed.

Advocate!

All three of these bills are critical to patients and pharmacies in Georgia and it is important your legislators hear from you on how important each of these bill are. These bills have been assigned to the House Special Committee on Access to Quality Healthcare. Please reach out to the committee members below, let them know you support the legislation, and thank them for their support and work on behalf of Georgia’s patients.

Newton, Mark – Chairman
Cooper, Sharon – Vice Chairman
Bentley, Patty
Corbett, John
Frye, Spencer
Hatchett, Matt
Houston, Penny
Jones, Todd
Knight, David
Nix, Randy
Parrish, Butch
Pirkle, Clay
Prince, Brian
Smith, Richard H.
Smyre, Calvin

SB 313: PBM Regulation

We are hopeful this PBM reform bill will be heard in full committee this week. Please reach out to committee members (below) and ask for their favorable support — thank them for their time and consideration. Between its initial hearing and subcommittee hearing, approximately five hours of committee time has been spent on this legislation, and we are optimistic this bill will be in a position to move forward.

Jones, Burt – Chairman
Martin IV, P. K. – Vice Chairman
Harbin, Marty
Sims, Freddie Powell
Unterman, Renee
Watson, Ben
Burke, Dean
Harbison, Ed
Kirkpatrick, Kay
Lucas, David
Robertson, Randy
Walker III, Larry

Other Legislation introduced in week 6

SB 391: Emergency refills

Introduced by Sen. Kirkpatrick, this bill requires health insurers to provide coverage for early refills of a 30 day supply of certain prescription medications under certain emergency situations. While the Board of Pharmacy does an excellent job of acting quickly in emergency situations such as hurricanes, this bill contemplates removing hurdles on the insurer side. GPhA will continue to engage on this legislation.

HB 952: Prohibiting Controlled substance limitations

Introduced by Rep. Cooper, this bill prohibits “corporations that own and operate multiple pharmacies from implementing policies and procedures that restrict the quantity of controlled substances dispensed or restrict the prescriber while at the same time protecting the ability of dispensing pharmacists to utilize their professional judgment. GPhA will monitor.

HB 961: Gathering info on state prescription drug spending

Rep. Park’s bill looks to create a list of prescription drugs for which the state expends significant healthcare funds and authorizes the AG to require info. from drug manufacturers. GPHA will monitor and engage.

Previously introduced legislation

SB 272: Dextromethorphan ban

Sen. Robertson’s legislation which looks to prohibit the sale to and by minors of drug products containing dextromethorphan was favorably reported out of committee. GPhA has remained engaged on this legislation over the past several years and will continue to monitor and engage as necessary.

Senate Insurance and Labor Committee

Jones, Burt – Chairman
Martin IV, P. K. – Vice Chairman
Harbin, Marty – Secretary
Sims, Freddie Powell – Ex-Officio
Unterman, Renee – Ex-Officio
Watson, Ben – Ex-Officio
Burke, Dean  (Also SB 313 Author)
Harbison, Ed
Kirkpatrick, Kay
Lucas, David
Robertson, Randy
Walker, III, Larry

Although there were no legislative days, week 5 proved to be a significant one for pharmacy. SB 313 was heard by the full Senate Insurance & Labor Committee on Monday, February 10. Several testified against the legislation including a PCMA representative. (PCMA is the association that advocates on behalf of PBMs.)

Testifying in support of the legislation were GASCO (Georgia Society of Clinical Oncology); MAG (Medical Association of Georgia); the National Multiple Sclerosis Society; and, of course, GPhA. There were also several members of the news media in attendance. Following a hotly contested meeting, Chairman Burt Jones assigned the bill to subcommittee consisting of Senator Larry Walker as chair, Senator P.K. Martin, and Senator Freddie Sims Powell.

The subcommittee held its first meeting on Wednesday in which Senator Burke introduced a substitute to SB 313. (Note: The substitute is not yet on the website.) It incorporated non-material changes requested by state agencies and also reinserted MAC pricing law protections, added a requirement that MAC methodologies be filed with the commissioner of insurance for use in investigating MAC appeals, deleted the requirement that PBMs utilize NADAC as a floor (due to fiscal concerns and the time it would likely take for a fiscal analysis), and requires PBMs to file public reports of reimbursements below and above certain thresholds of NADAC — including a a requirement that reimbursements to affiliates be identified.

The hearing itself was fiercely contested, with several PBM and insurer lobbyists and representatives testifying against the bill. Testifying in support of the bill were several patients as well as pharmacists Jennifer Shannon and Dawn Sasine along with Jessica Longtin, a manager at City Drugs in Vidalia. All three shared moving examples of how PBM practices have hurt patient care. GPhA also testified in support as did MAG. Another strong ally in attendance was patient advocacy organization Rx in Reach, which assisted with patient testimony and had a strong presence at the hearing.

This legislation remains under fire so, if your senator sits on the subcommittee or on the Senate Insurance & Labor Committee itself, please reach out and let them know how important this legislation is for your patients and for your practice, and ask for their support. It is important they hear from you as they are hearing from an unprecedented number of PBM and insurer lobbyists every day.

Senate Insurance and Labor Committee

Jones, Burt – Chairman
Martin IV, P. K. – Vice Chairman
Harbin, Marty – Secretary
Sims, Freddie Powell – Ex-Officio
Unterman, Renee – Ex-Officio
Watson, Ben – Ex-Officio
Burke, Dean – Member (Also SB 313 Author)
Harbison, Ed – Member
Kirkpatrick, Kay – Member
Lucas, David – Member
Robertson, Randy – Member
Walker, III, Larry – Member

Week 4 of Georgia’s legislative session (days 10-12) was relatively light on the introduction of healthcare legislation, although it was an exciting one for Georgia pharmacy with the first of two of GPhA’s Pharmacy Day at the Dome events. More than 250 students from UGA and PCOM descended on the Capitol to advocate for SB 313 and its goals of increasing transparency and protecting patients.

In other news, with concerns regarding the budget, the General Assembly passed a revised adjournment resolution (SR 712); it will recess until February 18. While there will be no legislation days during that time, certain committees, including appropriations, will continue to meet.

Legislation introduced in week 4

HB 888 and SB 359: Surprise billing

Introduced by Representatives Hawkins and Senator Hufstetler respectively, these companion bills look to address the problem of balanced billing, also known as surprise billing, which commonly occurs when an out-of-network provider cares for a patient at an in-network facility such as a hospital. This can often lead to patients receiving large and unexpected medical bills.

GPhA is supportive of efforts to protect patients and will continue to monitor and engage as these bills make their way through the General Assembly.

SB 348: Provider continuity

Introduced by Senator Kirkpatrick, this bill looks to ensure patients can continue to use a previously in-network provider for a period of at least 90 days following the departure of the provider from the network, subject to certain exceptions.

It also looks to ensure network sufficiency and gives the commissioner of insurance the ability to assess provider network adequacy. Significantly, pharmacists are included within the definition of “provider.” GPhA is in support of this legislation and will continue to follow it closely.

Previously introduced legislation

HB 759: Annual Drug Update

Representative Parrish’s drug update bill made its way through the Judiciary Non-Civil Committee and continues its journey to the House floor.

GPhA Members:

This year’s fight is just beginning, with one bill dropped in the Senate (SB313) and additional bills being dropped in the House very soon. The PBMs have brought in more lobbyists than ever to argue against our efforts to bring transparency and fair reimbursements to pharmacy, as well as curtail some of the heinous acts conducted by the PBMs.

We need your help again this year to pass our bills into law! And I’m sure this isn’t the last time we’ll be asking for your help this assembly.

SB313 is scheduled to be heard in a subcommittee on Wednesday. SB313 will:

• Bring true transparency to prescription drug pricing in Georgia by using public pricing benchmarks and requiring rebates to be passed back to payors
• Protect patients from certain practices including:
  • blocking access to cheaper generics
  • withholding coverage if a patient chooses not to use a PBM-owned pharmacy

We need you to take immediate action. Please reach out to the three senators on the subcommittee and urge their support of SB313. If written correspondence, please copy Senator Jones, chair of the Senate Insurance and Labor Committee on your e-mail or other communication. Senator Jones and the subcommittee’s contact information are listed below:

Senator Burt Jones
Chairman of the Senate Insurance and Labor Committee
(770) 775-4880
Burt.Jones@senate.ga.gov

Senator Larry Walker
Committee Member – Insurance and Labor Committee
(404) 656-0095
Larry.Walker@senate.ga.gov

Senator P.K. Martin
Vice Chairman, Committee Member – Insurance and Labor Committee
(404) 463-6598
p.k.martin@senate.ga.gov

Senator Freddie Powell Sims
Ex-Officio – Insurance and Labor Committee
(404) 463-5259

With all five days in session, legislative days 5-9 went by quickly. While there were not many bills introduced that impact pharmacy, as more fully elaborated below, week 2 proved to be a week of significance and consequence with one of the most sweeping PBMs bills ever introduced in the nation being dropped by Senator Dean Burke.

SB 313: PBM Regulation

Introduced by Senator Dean Burke, a physician from Bainbridge, SB 313 is a sweeping piece of PBM legislation that looks to, amongst other things:

• Do a much-needed update to existing provisions including definitions;
• Increase the commissioner of insurance’s authority and ability to audit and investigate PBM practices, and to fine for violations;
• Remove exemptions for Medicaid managed care;
• Replace the existing MAC pricing law and replace it with a requirement to base reimbursements off NADAC, a transparent federal public benchmark that prices drugs, and Georgia’s Select Specialty Pharmacy Rate for specialty drugs;
• Contemplate a reimbursement appeals process;
• Prohibit PBMs from tying the reimbursement of a drug to patient outcomes;
• Prohibit deriving revenue from patients and network pharmacies including retroactive recoupments;
• Act as a fiduciary to plans including passing along rebates;
• Prohibit spread pricing;
• Prohibit copay accumulator practices;
• Prohibit removing coverage for a drug for the purpose of incentivizing a patient to seek coverage from a different plan;
• Prohibit withholding coverage or requiring a prior authorization for a generic;
• Strengthen anti-steering provisions passed into law last year; and
• Impose a first-in-the-nation morals clause on PBMs that contract with the state — it would require them to abide by Georgia law for all services performed on Georgia claims.

Finally, to the extent PBMs continue to engage in practices of steering and imposing retroactive fees, this legislation will seek to implement a 10 percent surcharge on PBMs and their insurer clients on all claims administered in the state of Georgia. While never applied to PBMs in the country before, this provision sends a message that even if PBMs find a way around existing law, they are going to pay for it.

As powerful as this bill is, the support of senate leadership is equally powerful. With Senator Burke as the sponsor, the top cosponsors include Senator Ben Watson (chair of Senate Health and Human Services), Senator Mike Dugan (majority leader), Senator John Kennedy (majority caucus chairman), and Senator Chuck Hufstetler (chair of Senate Finance).

Please take the time to reach out and thank Senator Burke and the other cosponsors for their tremendous support and leadership. Clicking their names will bring you to their individual Web pages, which should include contact forms.

Upcoming Pharmacists at the Capitol events

There will be more to come on GPhA’s Pharmacists at the Capitol events once additional pharmacy legislation is introduced in the House.

Leading into Georgia’s 2020 legislative session, it was clear that issues pertaining to pharmacy were going to be front and center. The week before legislative session, on January 7, The House Insurance Committee and the House Special Committee on Access to Care convened to hear from patients, pharmacists, and physicians on PBM and managed care practices impacting Georgia’s patients, providers, and taxpayers.

Following the hearing, the House GOP issued a press release declaring its intention to ‘reverse the corporate takeover of Georgia Healthcare’ by introducing legislation that aims to: (1) bring true transparency to the prescription drug market; (2) seek a carve out of prescription drug benefits from Medicaid managed care; and (3) bring true oversight to PBMs and CMOs. Click here for the full press release.

Needless to say, GPhA fully supports these initiatives and looks forward to an exciting and busy 2020 legislative session that holds the potential to continue to bring true change to Georgia and improve conditions for pharmacy patients and pharmacies across the state. GPhA is grateful for the leadership and determination of the House GOP to continue to tackle problematic PBM practices.

Caroline Womack joins the GPhA advocacy team

In other huge news — news that has reverberated throughout Georgia’s government affairs community and the Capitol — GPhA has expanded its legislative team at the capitol by bringing on veteran lobbyist Caroline Womack to assist Greg Reybold and Cindy Shepherd. Caroline is one of the foremost healthcare lobbyists at the Capitol and offers a unique perspective and expertise in that she represented PCMA, the PBM industry’s trade association, for several years. The perspective, expertise, value, and work ethic she will bring to GPhA’s advocacy efforts is something for all of us to be excited about as we begin the session.

Week 1

Georgia’s 2020 legislative session convened on Monday, January 13, and GPhA was there. While none of GPhA’s legislative priorities were introduced, legislative days 1 through 3 were busy nonetheless with GPhA engaging in many discussions with legislators. While typically the first week can be light on pharmacy legislation, this year there were several pieces of legislation that GPhA will be tracking.

SB 293: Surprise Billing

Introduced by Senator Hoefstetler, the Balance Billing Consumer Protection Act looks to address the issue of surprise billing of patients. While this issue is seen most frequently in the emergency room setting, and it is not typically a problem in the retail pharmacy world, this bill is broadly written and potentially implicates retail pharmacies. As a result, GPhA will look to monitor and engage on this legislation, as well as other expected legislation, and ensure that pharmacy’s perspective is considered and understood.

HB 759: Annual Drug Update

Representative Parrish introduced the annual drug update bill which looks to update Georgia law with regard to controlled substances and dangerous drugs.

HB 791: Maintenance meds, 90-day supply

Representative Stephens introduced this bill which seeks to authorize a pharmacist to dispense up to a 90-day supply of a maintenance medication under certain conditions. This authorization would not extend to controlled substances.

Pharmacists and student pharmacists at the capitol

While GPhA is at the capitol daily advocating for pharmacists and their patients, the true voice and the true strength of the association lies with you, our members. That is why is so important that your legislators hear from you, their constituents, on issues that impact pharmacy.

With GPhA’s legislative priorities soon to be introduced, it is critical that our member pharmacists and student pharmacists continue to participate in GPhA’s Pharmacists at the Capitol and Day at the Dome events. Stay tuned as we will be releasing our first dates soon.

With no legislative days the week of January 20, the next legislative update will come on February 4 and will cover legislative days 4 – 8.

Should PBMs be allowed to claim ERISA to preempt state laws?

The Georgia House’s plan to rein in PBMs and Medicaid MCOs is getting some great press!

• WALB: “House GOP plans to reverse ‘corporate takeover’ of Ga. health care“
• Georgia House Press: “House Majority Caucus Unveils Plan to Reverse Corporate Takeover of Georgia Health Care“
• Jackson Progress-Argus: “Georgia House Majority Caucus plans to return health care decisions to patients“
• The Center Square: “Reducing drug costs is goal of Georgia proposal to rein in pharmacy benefit managers“
• The Brunswick News: “House leaders push for prescription meds overhaul“
• Valdosta Daily Times: “Lawmakers struggle to buoy local pharmacies“
• Georgia Recorder: “Georgia House Republicans say big pharmacy managers cause pain“

Click here for the detailed story, including a link to the full hearing video.

GOP to introduce legislation to bring transparency to prescription drug pricing, increase PBM and Medicaid CMO oversight, and carve prescription drug benefits Medicaid CMOs

In a rare pre-session hearing, leaders of the Georgia House of Representatives heard from pharmacists, physicians, and patients about how PBMs are flaunting Georgia law, hurting patient care, and driving smaller pharmacies out of business.

The issue

In 2019, Georgia passed HB 233, which prohibited most PBM “steering” of patients to their own pharmacies. Unfortunately, PBMs chose to ignore the law, requiring, for example, that patients use the mail-order pharmacies that the PBMs themselves own.

How can they do that? In other states, PBMs have claimed that they are not subject to state laws — that only the federal government has the right to regulate them.

Patients complained to their pharmacists and physicians. Pharmacists — led by GPhA — and physicians went to their legislators. And legislators decided to act.

What just happened

On January 7, a week before the opening of the 2020 legislative session, the Georgia House convened a Joint Special Committee on Access to Health Care and Insurance. It heard testimony from pharmacists, physicians, and their patients how the PBMs and Medicaid managed care organizations “rig the system” and end up hurting patient care.

GPhA members Nikki Bryant (owner of Adams Family Pharmacy in Preston) and Jennifer Shannon (owner of Lily’s Pharmacy in Johns Creek) were among those who testified.

“They don’t care about patients nor do they care about improving their disease states,” Shannon said about PBMs. “This local pharmacist does.”

Bryant lashed out at Medicaid MCOs: “Government contracts in this state that my taxpayer dollars are going to,” she said, “are working to put me out of business.”

What comes next

Immediately after the hearing, the House GOP — led by Georgia Representative David Knight — announced its intention to introduce legislation that Knight said (via a press release) would tackle those issues head on and “Reverse Corporate Takeover of Georgia Healthcare.”

Building on HB 233, this new legislation, Knight said, will “bring true transparency to the prescription drug market; while at the same time closing loopholes in existing laws that MCOs, PBMs, and even state-contracted PBMs use to continue to engage in practices that harm patients.”

Notably, the soon-to-be introduced bill will look to carve out prescription drug benefits from Medicaid managed care. In other words, it would pay Medicaid managed care organizations separately for prescription-drug benefits, allowing the state to better monitor and regulate the spending. (Knight pointed out that West Virginia implemented such a plan “and an actuarial study showed that the carve out saved over $50 million dollars while at the same time paying community pharmacies fairly.”)

The bill would also increase state oversight of both PBMs and the Medicaid managed-care organizations that contract and subcontract with the state.

Obviously it’s too soon to know the full details, but GPhA will have a close eye on what happens and will be keeping you informed. In the meantime, if you haven’t already, please visit the announcement on the Georgia House of Representatives’ Facebook page and add your name to the “Likes.” And share the news and press release wherever you can.

The 2020 General Assembly session opens next Monday, January 13.

Time to nominate someone to be honored with a 2020 GPhA award. If you know a pharmacist who has demonstrated the kind of professional commitment, dedication, or innovative spirit, let GPhA recognize it!

Click the big button to the right, or go to GPhA.org/awards to fill out the nomination form today!

To all our members across the state of Georgia (and beyond!)

To our volunteers who give of their time throughout the year, the pharmacists and techs who fill our classrooms;
the PharmPAC and foundation supporters, the citizen lobbyists who came to the Gold Dome;
the letter-writers, phone-callers, Facebook commenters, Twitter followers, Buzz readers;
the enthusiastic students and thoughtful mentors;
and to the hundreds of quiet, hard-working members who serve their patients and communities…

We say: Thank you!

Are you organized, discreet, and able to lift up to 30 pounds occasionally? GPhA is looking for an executive assistant and governance manager to succeed our outgoing staff member (whose name we won’t use because we’re angry at her for leaving).

The official description:

Provides operational, organizational and administrative support to effectively manage all aspects of the CEO’s office, including the administrative operation of the governance committee, board of directors, nominating committee, and other groups as assigned.

The basic requirements:

• Five years of increasingly responsible secretarial and administrative support work for management personnel.
• Experience in working for a CEO or top manager in an organization preferred.
• Associates degree or equivalent experience required; bachelor’s degree preferred.

Click here for a PDF with all the details and requirements of the position.

Anyone interested should send a thoughtful cover letter describing how your skills and experience meet the qualifications of this position to hr@gpha.org. Reference “Executive Assistant & Governance Manager” in the subject line.

Garnering much attention leading up to and during Georgia’s 2019 legislative session is the issue of THC and its treatment under Georgia law. Much of the discussion was driven by the federal passage of the 2018 Farm Bill which, amongst other things, redefined hemp to draw a distinction between marijuana and hemp — with hemp meaning the plant or any part with a THC concentration of not more than 0.3 percent; and allowed hemp cultivation and sale. This change, which occurred in late 2018, sparked confusion regarding legality of the sale at the state level of CBD oil containing THC.

Current Georgia law does not draw a distinction between marijuana and hemp, nor does it allow the sale of any THC oil in Georgia — hemp-derived or otherwise. However, if two bills that passed the general assembly become law (the governor has 40 days following legislative session to veto) there will be changes to Georgia’s status quo.

HB 213: The Georgia Hemp Farming Act

This bill looks to bring Georgia more in line with federal law as it relates to hemp with the purpose of, amongst other things, promoting expansion of Georgia’s hemp industry; encouraging research into growing hemp and creating hemp products; and enabling licensees and universities to promote the cultivation and commercial sale of hemp products.

The bill seeks to achieve these goals by:

• Defining hemp in the Georgia code to bring Georgia in line with the federal definition (THC level with a delta-9-THC concentration of not more than 0.3 percent on a dry weight basis);
• Allowing for issuance of hemp-grower licenses and a hemp-processor permits and prohibiting cultivation and processing without such a license or permit;
• Providing for oversight of cultivation and processing;
• Exempting hemp from the definition of marijuana in the Georgia code; and
• Carving hemp out of the list of schedule 1 controlled substances.

HB 324: An update to Haleigh’s Hope Act

At its core this legislation would allow the cultivation and sale of low-THC oil to patients with certain diseases authorized by law to receive it. Simple in explanation, but anything but in terms of application, this legislation has several moving parts. Below are some of the material highlights.

¶ Creation of the Georgia Access to Medical Cannabis Commission

The bill would create the Georgia Access to Medical Cannabis Commission with duties that include — but are not limited to…

• Execution of contracts to purchase or obtain low-THC oil from available legal sources with appropriated funds for use by registered patients;
• Establishing, maintaining, and administering a low-THC oil distribution network;
• Establishing procedures for inspecting production facilities and for quality control; and
• Issuing nontransferable university licenses for the production of low-THC oil.

¶ Dispensing of low-THC oil

By pharmacies (with BoP oversight). Significantly, the bill tasks the Georgia Board of Pharmacy with developing an annual nontransferable specialty-dispensing license for pharmacies to dispense low-THC oil to eligible patients, and it requires the BoP to create the appropriate rules and regulations.

By other retail outlets. The bill also authorizes the Access Commission to develop annual nontransferable dispensing licenses for retail outlets.

¶ Medical Cannabis Commission Oversight Committee

The bill establishes the four-member Medical Cannabis Commission Oversight Committee that is tasked generally with overseeing production in the state. More specifically, the Oversight Committee has authority to, amongst other things…

• Issue licenses related to production, growing, and manufacturing of low-THC oil;
• Coordinate with GBI to implement security plans;
• Establish procedures for granting licenses, testing products, and inspecting facilities; and
• Establish quality control and oversight of all low-THC oil production.

¶ Production licenses

• The Oversight Committee may issue up to two Class I production licenses after competitive application and review process enumerated in great detail in the bill (authorized to grow cannabis only in indoor facilities and limited to 100,000 square feet);
• The Oversight Committee may issue up to four Class 2 production licenses after a competitive application and review process (spelled out in great detail in the bill, but limited to growing cannabis only in indoor facilities and limited to 50,000 square feet)

Summary and preliminary assessment

With regard to the Hemp Farming Act, while not explicit, it appears that by carving hemp out of the definition of marijuana and from the Schedule I controlled substance list, the law should allow for the sale of hemp-derived CBD oil and other hemp products. However, because of Georgia’s definition of “low-THC” (not more than 5 percent THC) and its possible interplay with the hemp bill, questions remain. GPhA will look to engage with state officials and agencies should the bill become law.

With regard to the issue of low-THC oil, pharmacy now factors into the process in a major way. That said, pharmacies interested in participating should be wary as, with the exception of hemp, THC remains illegal on the federal level. There may be potential legal ramifications including criminal prosecution; and DEA number, payor agreement, loan, and lease exposure.

Should these bills become law, any pharmacy considering moving forward with the sale of hemp-based CBD oil or low-THC oil would be well advised to seek legal counsel to ensure compliance with the law.

This legislative update does NOT constitute any legal advice, does NOT establish any attorney-client relationship, and does NOT create any legal duty. Members and nonmembers should not rely on anything in this update when making a decision that may have legal consequences, but rather, should consult with qualified legal counsel.

With legislative day 40 — sine die — the lone legislative day in Week 12, there was much to wrap up in Georgia’s 2019 legislative session before the General Assembly adjourned for the year. First and foremost on the mind of Georgia’s pharmacists was GPhA’s two pieces of priority legislation, HB 233 and HB 323, which continued their improbable runs from introduction to passage by the General Assembly in one year. In particular, although both bills passed the Senate, they needed to go back to the House for an “agree,” in order to pass and go to the governor’s desk. They both did just that.

GPhA is grateful to Representative Knight, who carried both pieces of legislation; Senator Burke (carried HB 233 in the Senate); Senator Mullis (carried HB 323 in the Senate); and the many cosponsors and supporters of this legislation. Additionally, GPhA would like to thank the Georgia Society of Clinical Oncology for its support in advocating for this legislation.

Several other bills GPhA was engaged with and/or watching also made their way through the General Assembly. Remember that this year was the first year of the biennial legislative session, which means that bills that did not make cross over or sine die live to fight another year.

For an in depth discussion of legislation impacting pharmacy please join us at one of GPhA’s 12 region meetings for a legislative and regulatory briefing and join us at the Georgia Pharmacy Convention in June on Amelia Island for the important law update as well as other CPE sessions.

HB 233

HB 233 is a first of its kind patient-focused bill that will help to preserve patient choice and restrict pharmacies owned by pharmacy benefit managers and insurers from benefitting from widespread steering by their affiliates. This bill:

• Prohibits pharmacies owned by PBM and insurance affiliates from transferring or sharing records for commercial (i.e., non-patient care) purposes;
• Prohibit pharmacies from receiving self-dealing referrals from their affiliates and billing for them (referral includes ordering of patients to affiliate pharmacies; designing and implementing plan designs that require patient to use affiliate owned pharmacies; and patient-specific marketing by affiliates);
• Requires pharmacies to disclose affiliates to the Board of Pharmacy; and
• Gives the Board of Pharmacy oversight for this law, as the Board of Pharmacy already has existing oversight of licensed Georgia pharmacies (and pharmacies mailing into the state who must hold a non-resident pharmacy permit).

HB 323

HB 323 is an update to the Pharmacy Patient Protection Act of 2017. This bill regulates PBMs and does the following:

• Strengthens existing mandatory mail order provisions;
• Adds PBM transparency provisions in connection with rebates by requiring annual reporting of rebate information to payors/clients;
• Prohibits PBMs from steering patients to affiliate pharmacies;
• Prohibits sharing patient info with affiliate pharmacies for commercial purposes;
• Prohibits knowingly making misrepresentations to patients or providers;
• Restricts PBMs from charging fees or penalties in connection with audits;
• Applies existing law restricting onerous accreditation standards to PBMs; and
• Applies protections of this act to other dispensers such as oncologists and their patients.

Please note that neither bill restricts PBM-owned pharmacies from being included in networks, and contain exceptions for limited-distribution drugs not commonly carried by retail pharmacies and oncology clinics.

One more win

For the second year in a row, language was included in the budget that requires plan sponsors to report pharmacy claims to DCH, and requires DCH to prepare a report to the chairs of the House and Senate appropriations committees containing aggregated data. This report will provide information on PBM spread pricing as well as information regarding amounts of rebates and who kept them.

Georgia continues to be one of the early states looking into PBM spread pricing practices and insisting on transparency. Additionally, as a reminder, GPhA received a commitment from Georgia’s Medicaid managed care organizations to move away from spread pricing entirely in their future contracts with pharmacy benefits managers.

Other bills of note

HB 63

Rep. Cooper’s step therapy legislation, the changes to the bill were agreed to by the House and it now goes to the governor. GPhA is pleased to see this bill pass after coming close to the finish line in previous years.

HB 213

As previously reported, Rep. Corbett’s Hemp Farming Act was passed by the Senate and agreed to by the House in Week 11 and now awaits the Governor’s signature. GPhA will be providing further explanation of this legislation in the days to come.

HB 290

Rep. Cooper’s bill providing for a pilot program to offer preexposure prophylaxis drug assistance or services to persons at risk of being infected with HIV completed its journey through the General Assembly in week 11.

HB 324

Rep. Gravely’s update to Haleigh’s Hope Act (low-THC oil) went to conference committee and both the House and the Senate agreed to the Conference Committee report and the bill now goes to the governor. Pharmacy is central to this legislation, which would allow retail pharmacies to obtain a nontransferable specialty-dispensing license to dispense low-THC oil (once the rules are established by the Georgia Board of Pharmacy). GPhA will be providing a more in-depth analysis of HB 324 in the days to come and, assuming the legislation is signed by the governor, will be providing additional updates as this issue evolves.

HB 481

Rep. Setzler’s bill relating to abortion went to the governor in week 11. The bill, amongst other things, restricts abortions (subject to certain exceptions) after a heartbeat is detected. For purposes of pharmacists, it is important to note that the definition of abortion means “the act of using, prescribing, or administering any instrument, substance, device, or other means with the purpose to terminate a pregnancy….” As previously reported, pharmacists engaged in the practice of pharmacy are not liable under the legislation when providing care for a pregnant woman that results in the accidental or unintentional injury or death of an unborn child.

HB 483

As previously reported, Rep. Stephen’s annual drug update legislation awaits the governor’s signature.

HB 551

Rep. Hill’s legislation dealing with the regulation of kratom awaits the governor’s signature.

SB 103

Sen. Tillery’s legislation allowing the state to request Medicaid waivers was signed into law by Governor Kemp in Week 11. GPhA will continue to monitor the waiver process closely.

SB 115

Senator Unterman’s bill allowing telemedicine licenses to be issued to physicians who are licensed in other states went to the governor in week 11. Remember, this legislation also includes language from Rep. Stephen’s bill (HB 214) removing the requirement that a physician entering into a vaccine protocol agreement with a pharmacist must be in the same health district was added into this legislation.

SB 118

Also going to the governor in week 11 was Sen. Unterman’s TeleHealth Act establishing, amongst other things, a prohibition on insurers requiring patients to use telemedicine, and pay equity for providers using telemedicine.

SB 121

Sen. Walker’s PDMP revision bill completed its journey through the General Assembly in week 10. This bill increases the time prescription information is maintained from two to five years and would authorize the attorney general’s Medicaid Fraud Unit to access the PDMP database for enforcement purposes.

SB 142

Sen. Walker’s bill requiring fully insured plans include a statement saying so on health insurance identification cards was agreed to by the House on day 40 and is off to the governor’s office.