Prior Authorization in Georgia
Georgia enacted the Patient Step Therapy Act (SB 75, 2020) requiring health plans to provide step therapy exception processes. Exceptions must be granted when the required drug is contraindicated, expected to be ineffective based on clinical history, or the patient has already tried and failed the step. GA also requires peer-to-peer review on request.
Key Facts About PA in Georgia
- ✓ Step therapy exception process required for all health plans
- ✓ Exceptions for contraindications, expected inefficacy, and prior treatment failure
- ✓ Prescribers can request peer-to-peer review with a plan medical director
- ✓ External review available through the Georgia Office of Insurance
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Georgia
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Georgia carriers:
Anthem BCBS GeorgiaUnitedHealthcareAetnaKaiser Permanente Georgia