Ga. Code § 33-46-23.1

Current through 2023-2024 Legislative Session Chapter 709
Section 33-46-23.1 - Prior authorization of prescription medications for chronic conditions
(a) As used in this Code section, the term:
(1) "Chronic condition" means a serious, long-term, physical, mental, or developmental disability or disease.
(2) "Ongoing medication therapy" means a clinical and evidence-based treatment that uses a prescribed medicine to prevent, diagnose, treat, or relieve the symptoms of a chronic condition and is continuing or expected to continue for at least a year.
(b) Unless otherwise provided in subsection (c) of this Code section or prohibited by state or federal law, if a healthcare provider receives a prior authorization for a medication prescribed to a covered person with a chronic condition that requires ongoing medication therapy, and the provider continues to prescribe the medication, and the medication is used for a condition that is within the scope of use approved by the United States Food and Drug Administration or has been proven to be a safe and effective form of treatment for the patient's specific underlying condition based on clinical practice guidelines that are developed from peer-reviewed publications, the prior authorization received shall:
(1) Be valid for the lesser of:
(A) One year from the date the healthcare provider receives the prior authorization; or
(B) Until the last day of coverage under the covered person's healthcare plan; and
(2) Cover any change in dosage prescribed by the healthcare provider during the period of authorization.
(c)
(1) This Code section shall not apply to:
(A) Medications that are prescribed for a nonmaintenance condition;
(B) Medications that have a typical treatment period of less than 12 months;
(C) Medications for which medical or scientific evidence does not support a 12 month approval, including medications where an initial shorter duration approval is necessary to demonstrate appropriate response to therapy; or
(D) Medications that are opioid analgesics or benzodiazepines.
(2) Nothing in this Code section prevents the prior authorization of a medication for more than a year if permissible by the covered person's healthcare plan.

OCGA § 33-46-23.1

Added by 2022 Ga. Laws 830,§ 1, eff. 1/1/2023.