Requirements and procedures affecting pharmacy benefits managers; surety bond

(a) Every applicant for a pharmacy benefits manager’s license shall file with the application and shall thereafter maintain in force a bond in the amount of $100,000.00 in favor of the Commissioner executed by a corporate surety insurer authorized to transact insurance in this state. The terms and type of the bond shall be established by rules and regulations. (b) The bond shall remain in force until the surety is released from liability by the Commissioner or until the bond is canceled by the surety. Without prejudice to any liability accrued prior to cancellation, the surety may cancel the bond upon 30 days’ advance notice, in writing, filed with the Commissioner. (c) Every applicant for a pharmacy benefits manager’s license shall obtain and shall thereafter maintain in force errors and omissions coverage or other appropriate liability insurance, written by an insurer authorized to transact insurance in this state, in an amount of at least $250,000.00. (d) The coverage required in subsection (c) of this Code section shall remain in force for a term of at least one year and shall contain language that includes that the insurer may cancel the insurance upon 60 days’ advance notice filed with the Commissioner. Other terms and conditions relating to the errors and omissions policy may be imposed on the applicant in accordance with rules and regulations. (e) In the event a licensed pharmacy benefits manager fails to renew, surrenders, or otherwise terminates its license, it must retain both the 1079 33-64-5 bond and the errors and omissions coverage for a period of not less than one year after the licensee has failed to renew, surrendered, or otherwise terminated the license. History. — Code 1981, § 33-64-3, enacted by Ga. L. 2010, p. 757, § 1/SB 310. 33-64-4. (For effective date, see note.) Pharmacy benefits manager shall not engage in the practice of medicine; recommended use of licensed physician. (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.