PBMs are prohibited from charging or holding a pharmacist, pharmacy, or dispenser or dispenser practice responsible for a fee relating to the adjudication of a claim, or recouping funds from a pharmacy in connection with claims for which the pharmacy has already been paid without first complying with the statutory fair audit requirements. Effective July 1, 2021, a PBM is prohibited from engaging in any practice that (A) In any way bases pharmacy reimbursement for a drug on patient outcomes, scores, or metrics; provided, however, that nothing shall prohibit pharmacy reimbursement for pharmacy care, including dispensing fees from being based on patient outcomes, scores, or metrics so long as the patient outcomes, scores, or metrics are disclosed to and agreed to by the pharmacy in advance; (B) Includes imposing a point‐of‐sale fee or retroactive fee; or (C) Derives any revenue from a pharmacy or insured in connection with performing pharmacy benefits management services; provided, however, that this shall not be construed to prohibit pharmacy benefits managers from receiving d d ibl.

Link to Existing Law: GA ST 33‐64‐1 et. seq

Georgia was one of the earliest states attacking PBM clawbacks and it now includes language to apply to dispenser or dispenser practice. Additionally, recently enacted language appears to further prevent DIR fees, though some of the language appears contradictory and may require regulatory or court guidance to be fully fleshed out. It must be noted that these requirements may be limited to insurance plans regulated by the State, and may exclude Medicare Part D, and TRICARE plans.