Subcommittee hears HB 100 to require pharmacy rebates be passed to consumers at point of sale

Collier Williams, representing the National MS Society, told the Insurance Subcommittee on Life and Health that House Bill 100 would require insurers and pharmacy benefit managers (PBMs) to pass at least 80% of negotiated rebates and discounts directly to consumers at the point of sale. Williams urged the committee to support the measure to reduce out‑of‑pocket drug costs for people with multiple sclerosis and others who rely on disease‑modifying therapies.

"House Bill 100 would require that insurance plans and pharmacy benefit managers or PBMs share the financial benefit directly with the consumer at the point of sale," Collier Williams said. He cited a society survey finding that 40 percent of people on disease‑modifying therapies altered or stopped taking medication because of cost and said "ensuring that at least 80% of these negotiated rebates and discounts are passed on to consumers" would lower out‑of‑pocket expenses.

Jesse Wetherington, president of the Georgia Association of Health Plans, testified in opposition. He argued the proposal would undermine the insurance model of collective pooling by directing rebates to individuals at the counter and shifting costs onto the broader pool — particularly small businesses that buy coverage. "This is a mandate on small businesses," Wetherington said, and he noted market options for point‑of‑sale rebate plans already exist but have limited uptake because they raise premiums for the whole pool. He also noted that some plans are exempt under federal law (ERISA) and that the State Health Benefit Plan and Medicaid implications would affect fiscal impact and coverage scope.

A representative of the Pharmacy Care Management Association (PCMA) testified against the measure and said the bill has repeatedly been proposed in past sessions; industry witnesses raised practical implementation problems, including that rebate calculations are sometimes finalized in arrears and may be difficult to adjudicate at the pharmacy counter. Wetherington and other industry witnesses also said many plans already offer point‑of‑sale options but that mandating them would raise premiums for most plan participants to subsidize a small share of high‑cost brand‑drug users.

Committee members asked about ERISA and State Health Benefit Plan exemptions; witnesses confirmed ERISA plans would be treated as exempt where applicable and that the proposed bill would have implications for SHBP and Medicaid and therefore could require a fiscal note. The committee did not take a vote; the hearing was informational.

The testimony laid out competing policy tradeoffs: patient advocates emphasized immediate relief at the pharmacy counter to lower adherence barriers, while insurers and PBMs warned of cost shifting and operational challenges for calculating rebates at point of sale.

The item remains at the committee stage following the hearing.