Bill Text: CA AB1826 | 2009-2010 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health care coverage: prescriptions.

Spectrum: Partisan Bill (Democrat 11-0)

Status: (Engrossed - Dead) 2010-08-12 - In committee: Held under submission. [AB1826 Detail]

Download: California-2009-AB1826-Amended.html

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BILL NUMBER: AB 1826	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 28, 2010
	AMENDED IN ASSEMBLY  MARCH 15, 2010

INTRODUCED BY   Assembly Members Huffman and Feuer
   (Coauthors: Assembly Members Beall, Blumenfield,  Hill, 
and Saldana)
   (Coauthors: Senators  DeSaulnier,  Pavley, Price, and
Yee)

                        FEBRUARY 11, 2010

   An act to add Section 1367.225 to the Health and Safety Code, and
to add Section 10123.197 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1826, as amended, Huffman. Health care coverage: prescriptions.

   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires a health care service plan contract or a health
insurance policy covering prescription drug benefits to provide
specified coverage to subscribers, enrollees, and insureds.
   This bill would require a health care service plan or health
insurer covering prescription drug benefits to provide coverage for a
drug that has been prescribed for the treatment of pain without
first requiring the subscriber, enrollee, or insured to use another
drug or product.
   The bill would specify that these provisions do not apply to a
health care service plan or health insurance policy purchased by the
Board of Administration of the Public Employees' Retirement System.
   Because a willful violation of the bill's requirements with
respect to health care service plans would be a crime, the bill would
impose a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1367.225 is added to the Health and Safety
Code, to read:
   1367.225.  (a) Every health care service plan  that covers
  covering  prescription drug benefits shall
provide coverage for a drug that has been prescribed by a
participating licensed health care professional for the treatment of
pain without first requiring the subscriber or enrollee to use an
alternative prescription drug or an over-the-counter product.
   (b) This section does not prohibit a health care service plan from
charging a subscriber or enrollee a copayment or a deductible for
prescription drug benefits or from setting forth, by contract,
limitations on maximum coverage of prescription drug benefits,
provided that the copayments, deductibles, or limitations are
reported to, and held unobjectionable by, the director and set forth
to the subscriber or enrollee pursuant to the disclosure provisions
of Section 1363.
   (c) This section shall not apply to a health care service plan
purchased by the Board of Administration of the Public Employees'
Retirement System pursuant to the Public Employees' Medical and
Hospital Care Act (Article 1 (commencing with Section 22750) of
Chapter 1 of Part 5 of Division 5 of Title 2 of the Government Code).

   (d) Nothing in this section shall be construed to require coverage
of prescription drugs not in a plan's drug formulary or to prohibit
generic drug substitutions as authorized by Section 4073 of the
Business and Professions Code. 
  SEC. 2.  Section 10123.197 is added to the Insurance Code, to read:

   10123.197.  (a) Every health insurer  that covers
  covering  prescription drug benefits shall
provide coverage for a drug that has been prescribed by a licensed
health care professional for the treatment of pain without first
requiring the insured to use an alternative prescription drug or an
over-the-counter product.
   (b) This section does not prohibit a health insurance policy from
charging an insured a copayment or a deductible for prescription drug
benefits or from setting forth, by contract, limitations on maximum
coverage of prescription drug benefits, provided that the copayments,
deductibles, or limitations are reported to, and held
unobjectionable by, the commissioner and set forth to the insured
pursuant to the disclosure provisions of Section 10603.
   (c) This section shall not apply to a health insurance policy
purchased by the Board of Administration of the Public Employees'
Retirement System pursuant to the Public Employees' Medical and
Hospital Care Act (Article 1 (commencing with Section 22750) of
Chapter 1 of Part 5 of Division 5 of Title 2 of the Government Code).

   (d) Nothing in this section shall be construed to require coverage
of prescription drugs not in an insurer's drug formulary or to
prohibit generic drug substitutions as authorized by Section 4073 of
the Business and Professions Code. 
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.