Georgia 2025-2026 Regular Session

Georgia House Bill HB654

Caption

Insurance; prohibit insurers from conditioning the payment of any medical test or procedure or prescription drug benefit on prior authorization

Impact

If enacted, HB 654 will alter existing regulations in the realms of health insurance and medical practice. The bill specifically prohibits conditions that might impede timely access to necessary healthcare, thereby reinforcing patient autonomy and potentially improving health outcomes. By removing requirements for prior authorizations, healthcare providers could focus more on patient care rather than administrative duties, leading to a more efficient healthcare model. Furthermore, the implications of this legislation could extend to state employees’ health insurance plans, establishing broader accessibility benchmarks.

Summary

House Bill 654 primarily seeks to amend several provisions of the Official Code of Georgia to prohibit insurers and pharmacy benefit managers from requiring prior authorization for prescription drugs and medical tests. This legislative effort aims to streamline healthcare access by ensuring that patients can receive prescribed medications and treatments without delays associated with insurance approvals. Particularly, the bill addresses the payment conditions imposed by insurers, asserting that covered services prescribed by licensed healthcare providers should not be contingent on prior authorizations, which can delay critical healthcare services.

Contention

While the bill introduces provisions aimed at enhancing healthcare delivery, potential points of contention may arise regarding its impact on the insurance industry. Opponents may argue that without prior authorization, there could be an increase in healthcare costs or misuse of services, affecting the sustainability of health insurance programs. Supporters, on the other hand, maintain that the current authorization requirements create unnecessary barriers for patients and that easing these restrictions could promote overall public health. The ongoing debate will likely revolve around balancing patient access with the economic realities of healthcare provision.

Companion Bills

No companion bills found.

Previously Filed As

GA S3123

Prohibits pre-approval or precertification of medical tests, procedures and prescription drugs covered under health benefits or prescription drug benefits plans.

GA A249

Prohibits pre-approval or precertification of medical tests, procedures and prescription drugs covered under health benefits or prescription drug benefits plans.

GA S0684

Prohibits a policy of individual health insurance coverage from requiring prior authorization for prescriptions of generic medication.

GA SB317

Prohibit health insurers from performing prior authorization on psychiatric drugs in shortage or discontinued

GA S2374

Prohibits pre-approval or precertification of cancer treatments, tests, procedures and prescription drugs covered under health benefits or prescription drug benefits plans.

GA H6317

Prohibits an insurer from imposing a requirement of prior authorization for any admission, item, service, treatment, test, exam, study, procedure, or any generic or brand name prescription drug ordered by a primary care provider.

GA SB20

Prior Authorization & Prescription Drugs

GA SF2477

Health insurance, Medicare supplement benefits and prescription drugs provisions modifications

GA S0786

Prohibits prior authorization or a step therapy protocol for the prescription of a nonpreferred medication on their drug formulary used to assess or treat an enrollee's bipolar disorder, schizophrenia or schizotypal.

GA HB1808

Health insurance; creating the Ensuring Transparency in Prescription Drugs Prior Authorization Act; determination; consultation; prior authorization; effective date.

Similar Bills

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RI H7030

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AR HB1299

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RI H7941

Requires insurers to pay electronic claims for healthcare coverage within 14 calendar days of receipt. Permits healthcare providers to dispute claim denials within 60 days and empowers the secretary of EOHHS to establish penalties for violations.

AR HB1301

To Amend The Prior Authorization Transparency Act.

RI H8310

Amends the timelines related to healthcare provider credentialing.

MA S1632

Providing safeguards for home healthcare workers

MA H2364

Providing safeguards for home healthcare workers