Among the coming year’s law changes in Georgia, the biggest revolves around the enactment of the Pharmacy Anti-Steering and Transparency Act—also referred to as the GA Act. This was put in motion to address the issues around negligent pharmacy benefit managers (PBMs) and insurers steering patients to pharmacies without regulatory oversight or transparency.
It’s important to note that the GA Act is not the only law going into effect in 2020. If you’re interested in learning more about the law changes coming to Georgia in 2020, you can check out this blog. For now, let’s take a closer look at what the Pharmacy Transparency Act means for healthcare providers and state residents.
The Purpose of the Pharmacy Transparency Act
The issue with PBMs and insurers is that they’re mining patient data in an attempt to steer patients to pharmacies affiliated with those companies. As a result, there’s limited patient choice, a waste of resources, increased costs, and lower quality of care to patients. The Pharmacy Anti-Steering and Transparency Act was enacted in an attempt to meet three goals:
- To ensure patients receive high-quality care in regard to prescription medications
- To allow patients to choose their pharmacies
- To increase transparency
Prior to the passing of this Act, a pharmacist and oncologist testified about PBM-owned pharmacies. According to their statements, those pharmacies mandate that patients only use certain mail-order pharmacies to fill their prescriptions. As a result, patients do not have access to healthcare professionals to address managing their medications. Additionally, those pharmacies were found to consistently supply incorrect dosages and medications when sent by mail. In some cases, medications requiring refrigeration were left on doorsteps for hours and some patients experienced delays with the medication they needed promptly.
Protecting Patients with Prohibited Actions
To meet the goals discussed above and protect patients, the GA Act prohibits licensed pharmacies from certain actions. The first is not being allowed to transfer or share prescription records with patient information for any non-patient care purpose or commercial purpose. This prohibition does not apply to the exchange of information between a pharmacy and its affiliate, which refers to an entity with an investment or ownership in the pharmacy, for the purpose of pharmacy reimbursement or care, formulary compliance, public health activities authorized by the law, and healthcare provider reviews.
The second prohibited act is presenting a claim for payment for a service that resulted from a referral from an affiliate. A referral is when a patient is ordered to go to a certain pharmacy, offered plan designs that require the use of an affiliate pharmacy, or receives advertising, marketing, or promotion of a pharmacy by an affiliate.
In addition to the prohibited actions and to promote transparency, Georgia pharmacies are required to file annually with the Pharmacy Board and disclose a statement identifying its affiliates.
GA Act Exceptions
While the 2020 Pharmacy Transparency Act addresses issues within healthcare in the state and will help protect patients in the future, there are some things the Act does not do. It does not prohibit a pharmacy from entering into an agreement with an affiliate as long as the pharmacy submits the annual disclosure and doesn’t receive referrals.
Additionally, the GA Act does not apply to the following:
- Licensed group model health maintenance organization with an exclusive medical group contract
- Referrals by an affiliate pharmacy for services and prescriptions to patients in skilled nursing facilities, intermediate care facilities, continuing care retirement communities, home health agencies, and hospices
- Georgia Medicaid care management organizations
If you have questions about the GA Act or think you’ve been the victim of negligent pharmacy benefit managers and insurers, consider getting in touch with Bey & Associates. There could be grounds to file a medical malpractice case. We stay up-to-date on important laws that impact personal injury claims, so we can explain what your options are if you were injured as a result of pharmacy steering or incorrect medication. To learn more about your legal rights and options, contact us today.
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