(a) No pharmacy benefits manager shall engage in the practice of medicine, except as otherwise provided in subsection (b) of this Code section.(b) Any physician employed by or contracted with a pharmacy benefits manager advising on or making determinations specific to a Georgia insured in connection with a prior authorization or step therapy appeal or determination review shall: (1) Have actively seen patients within the past five years; and(2) Have practiced in the same specialty area for which he or she is providing advisement within the past five years.(c) For contracts and amendments entered into with a pharmacy benefits manager on and after July 1, 2021, the department is encouraged to require the use of a licensed Georgia physician for prior authorization or step therapy appeal or determination reviews.Amended by 2020 Ga. Laws 584,§ 3, eff. 7/1/2021.Amended by 2020 Ga. Laws 583,§ 3, eff. 7/1/2021.Added by 2010 Ga. Laws 549,§ 1, eff. 1/15/2011.
Georgia Legal Code