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House approves NAADAC-based reimbursement to shore up independent pharmacies
Summary
House Bill 196 passed Feb. 21, 2025, creating a reimbursement formula for drugs dispensed to covered persons under the state health insurance plan using NAADAC-based pricing plus a dispensing fee. Sponsors said the measure will help independent pharmacies in rural Georgia that have been reimbursed below acquisition cost.
The Georgia House passed House Bill 196 on Feb. 21, 2025, a bill intended to guarantee a floor for reimbursement to pharmacies when filling prescriptions under the state employees health insurance plan. Sponsor Representative Kelly said the bill creates a guaranteed reimbursement rate tied to the National Average Drug Acquisition Cost (NAADAC) plus a reasonable dispensing fee.
Nut graf: Sponsors, committee chairs and supportive members described the measure as a step to keep independent pharmacies financially viable after years of compressed reimbursements from pharmacy benefit managers (PBMs). Floor speakers cited specific examples of pharmacies filling medications at a loss to avoid leaving patients without necessary drugs.
During floor debate, Representative Kelly described a case in which a rural pharmacist faced a choice: not fill two urgent prescriptions or fill them and lose about $500. Chairman Allen Powell called the measure a matter of fairness toward small businesses. Representative Stevens provided an example comparing a specialty drug price quoted by a PBM — roughly $3,833 — to a NAADAC-based cost in the low tens of dollars, arguing the disparity shows the need for reform.
The bill passed unanimously in a recorded vote, yeas 168, nays 0. Supporters said the legislation will increase price transparency and protect patients who rely on community pharmacies for primary access to medicines in rural areas.
Clarifying details in debate: the bill ties state-plan reimbursement to NAADAC pricing plus a dispensing fee; sponsors framed the policy as part of a larger effort to address PBM practices and specialty-drug routing to mail-order or specialty pharmacies. Exact budgetary effects were not provided on the floor; sponsors said the change could increase state costs modestly but argued it would preserve access and could reduce higher overall plan costs tied to specialty pharmacy arrangements.
Provenance: presentation and discussion began at s=7565.13; committee chairs and multiple members spoke in support; final vote recorded at s=8596.415.
