Committee advances substitute to HB196 to set pharmacy reimbursement floor for state health plan; fiscal note pending

The Georgia House Health Committee voted to report LC570229S, a substitute to House Bill 196 that sets a minimum reimbursement calculation for pharmacies that dispense drugs to covered persons under the state health plan.

Under the substitute described by Representative Trey Kelly, reimbursement to a pharmacy would be the sum of the national average drug acquisition cost (NADAC) or another acquisition benchmark if NADAC is unavailable, plus a professional dispensing fee that would be no less than the fee paid under Title XIX (the Social Security Act) for the state’s Medicaid program; the prior draft also included a modest percent add‑on (4% of NADAC or $50, whichever is less), which was revised while the committee worked with the Department of Community Health (DCH).

Why it matters: Supporters framed the bill as a way to protect independent and local pharmacies by providing a reasonable reimbursement floor and to ensure the state health benefit plan (state employees and university employees) preserves access to local dispensing pharmacies.

Agency input and fiscal note: Dean Burke, chief medical officer at the Department of Community Health, and DCH staff described the process by which DCH and external consultants (Aon) and the incumbent PBM (CVS Caremark) provided cost estimates. Committee members and the sponsor emphasized they will ensure an appropriation in fiscal year 2026 to cover any state health benefit plan impact. Several members asked for and were told the fiscal note is ongoing and will be provided to the committee later.

Vote and next steps: The committee approved LC570229S by voice vote. The transcript records the committee’s favorable vote and notes that a final fiscal note will be provided later; no roll‑call tally was recorded in the transcript.