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Georgia Code Title 33. Insurance § 33-46-23.1

Current as of March 28, 2024 | Updated by Findlaw Staff

(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.

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Cite this article: FindLaw.com - Georgia Code Title 33. Insurance § 33-46-23.1 - last updated March 28, 2024 | https://codes.findlaw.com/ga/title-33-insurance/ga-code-sect-33-46-23-1/

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