Pharmacy Benefits Managers; managers have a duty of care to insureds, health plans, and providers; provide
SB 60 would significantly expand Georgia’s regulation of pharmacy benefits managers (PBMs). The bill updates the state’s PBM definitions and adds new terms covering concepts such as spread pricing, rebates, steering, retroactive fees, point-of-sale fees, and pharmacy benefits management services. It also clarifies which entities are included in or excluded from the definition of a PBM, including certain hospital pharmacies, health systems, and some affiliated pharmacy arrangements.
The core policy change is the creation of a statutory “pharmacy benefits manager duty” owed by PBMs to insureds, health plans, and providers. That duty requires PBMs to act with care, skill, prudence, diligence, fairness, transparency, and professionalism, and in the best interests of the relevant party. The bill directs the Commissioner of Insurance to adopt regulations defining the scope of these duties, including transparency requirements related to formulary design, utilization management, grievances and appeals, conflicts of interest, and identifying spread pricing. It also gives aggrieved parties a private right of action to sue PBMs in state court for violations.
The bill would affect Georgia’s insurance and pharmacy-benefit regulatory framework by adding enforceable duties and new disclosure obligations for PBMs operating in the state. It would likely increase compliance requirements for PBMs and could affect how they contract with health plans, insurers, pharmacies, and providers, especially regarding pricing practices and affiliate pharmacy relationships. The bill also states that federal law controls where there is a conflict and limits state regulation to what is permissible under applicable law.
Overall sentiment appears favorable toward tighter PBM oversight, based on the bill’s structure and sponsors, but no committee transcripts or recorded votes were provided to show debate or opposition. The bill’s emphasis on transparency, conflicts of interest, and consumer protection suggests a reform-oriented approach aimed at addressing concerns about PBM pricing practices and steering to affiliated pharmacies.
The main points of contention likely center on the breadth of the new fiduciary-like duties, the private right of action, and the potential impact on PBM business models and negotiated drug pricing arrangements. PBMs and possibly insurers may object to increased liability and disclosure burdens, while pharmacies, providers, and insureds may support the bill’s transparency and anti-steering provisions. Because no hearing record is included, these concerns are inferred from the bill’s provisions rather than from documented testimony.
SB 60 would amend Georgia’s PBM licensing and regulation chapter in Title 33 by adding detailed definitions and by imposing a new statutory duty of care, good faith, fairness, and transparency on pharmacy benefits managers. It would require the Insurance Commissioner to promulgate rules implementing those duties and would authorize civil lawsuits by aggrieved insureds, health plans, and providers. The bill would therefore expand state oversight of PBM conduct and create new legal exposure for PBMs operating in Georgia.
No committee transcripts or vote history were provided, so there is no direct record of legislative debate or recorded support/opposition. Based on the bill’s sponsors and its consumer-protection and transparency focus, the measure appears to be intended as a reform bill aimed at curbing PBM practices such as spread pricing, steering, and undisclosed conflicts of interest. The likely general sentiment among supporters would be favorable toward stronger PBM accountability, while opponents would likely be concerned about regulatory burden and litigation risk.
The most likely areas of contention are the bill’s creation of a PBM duty owed to insureds, health plans, and providers; the requirement for transparency around pricing and conflicts of interest; and the private right of action allowing lawsuits in state court. PBMs and affiliated entities would likely argue that the bill could interfere with negotiated rebates, pricing arrangements, and plan administration, while pharmacies, providers, and patient advocates would likely support the anti-steering and disclosure provisions. The bill also expressly prioritizes duties to insureds over other parties and providers over health plans in conflicts, which could be another source of dispute.