State Tracker Updated June 15, 2026

Georgia: what the PBM reimbursement law requires

Georgia has enacted a NADAC-plus-dispensing-fee reimbursement floor, but only for state health plans (state employees, teachers, and the University System). A broader commercial floor remains pending.

Status	Partially enacted
Law	HB 196 (2025) — O.C.G.A. § 45-18-22 (state plans); HB 810 (commercial floor) pending
Effective date	State-plan floor effective January 1, 2026
Reimbursement basis	A reimbursement floor is in force for state health plans only: NADAC on the day of claim adjudication (or a discounted AWP/WAC if NADAC is unavailable) plus a professional dispensing fee of at least $10.50 for chain pharmacies and $11.50 for independents, with an anti-circumvention clause. A broader commercial floor (HB 810, NADAC + $10.64) has not passed.
Professional dispensing fee	$10.50 (chain) / $11.50 (independent) — for state-plan claims only
Appeal route	Floor enforced by the Commissioner of Insurance; Georgia's separate MAC/appeal rules sit in O.C.G.A. Title 33, ch. 64

Georgia’s enacted floor is real but narrowly scoped. HB 196 (O.C.G.A. § 45-18-22, effective January 1, 2026) requires reimbursement at NADAC plus a professional dispensing fee — at least $10.50 for chains and $11.50 for independents — but only for the state health plan: state employees, public-school teachers and employees, and the University System of Georgia. It does not reach private commercial plans, Medicaid managed care, or self-funded plans.

A broader commercial floor (HB 810, NADAC + $10.64) advanced out of committee in early 2026 but has not passed either chamber, so it is not yet law. Georgia is therefore shown here as partially enacted: a genuine floor for state-plan coverage, with the commercial floor still pending.

Sources

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