Bill Text: CA AB2050 | 2015-2016 | Regular Session | Amended
Bill Title: Health care coverage: prescription drugs: refills.
Sponsorship: Partisan Bill (Republican 1)
Status: (Failed) 2016-11-30 - From Senate committee without further action. [AB2050 Detail]
Download: California-2015-AB2050-Amended.html
BILL NUMBER: AB 2050 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 6, 2016
AMENDED IN ASSEMBLY MARCH 18, 2016
INTRODUCED BY Assembly Member Steinorth
FEBRUARY 17, 2016
An act to add Section 1367.248 to the Health and Safety Code, and
to add Section 10123.208 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2050, as amended, Steinorth. Health care coverage: prescription
drugs: refills.
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 also provides for the
regulation of health insurers by the Department of Insurance.
Existing law imposes various requirements on contracts and policies
that cover prescription drug benefits. Existing law, the Pharmacy
Law, provides for the licensure and regulation of pharmacists by the
California State Board of Pharmacy and prohibits the refilling of a
prescription without the authorization of the prescriber, except as
specified.
This bill would require a health care service plan contract or
health insurance policy issued, amended, or renewed on or after
January 1, 2017, that provides coverage for prescription drug
benefits to implement a medication synchronization policy
program for the dispensing of prescription drugs
by a single retail network pharmacy so that prescriptions
that are refilled at the same frequency may be filled
concurrently. concurrently for the purpose of
improving medication adherence or if it is in the best interest of
the enrollee or insured, as specified. Because a willful
violation of the bill's requirements by a health care service plan
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 1367.248 is added to the Health and Safety
Code, to read:
1367.248. (a) A health care service plan contract issued,
amended, or renewed on or after January 1, 2017, that provides
coverage for prescription drug benefits shall implement a
synchronization policy program for the
dispensing of prescription drugs to the plan's
enrollees.
(b) For purposes of this section, "synchronization policy" means a
procedure for aligning the refill dates of an enrollee's
prescription drugs so that prescriptions that are refilled at the
same frequency may be refilled concurrently.
(b) In implementing the synchronization program pursuant to this
section, all of the following shall apply:
(1) The plan shall not deny coverage for a prescription drug
covered by the health care service plan contract that is dispensed by
a network pharmacy for less than the standard refill amount for the
purpose of improving medication adherence or if the enrollee agrees
that synchronizing his or her medications is in his or her best
interest.
(2) The plan shall accept early refill and short-fill requests for
prescription drugs using the submission clarification and message
codes adopted by the National Council for Prescription Drug Programs
or alternative codes provided by the plan.
(3) The plan may apply a prorated daily cost-sharing rate for
maintenance prescription drugs that are dispensed by a network
pharmacy for the purpose of synchronizing the enrollee's medications.
(4) The plan may impose a limit on the number of synchronization
attempts in a contract year. The limit may be established by the plan
in an amount of not less than four attempts per year.
(c) For purposes of this section, "synchronization program" means
a procedure for aligning the refill dates of an enrollee's
prescription drugs that are being dispensed by a single retail
network pharmacy so that prescriptions that are refilled at the same
frequency may be refilled concurrently for the purpose of improving
medication adherence or if it is in the best interest of the
enrollee.
(d) This section does not apply to any of the following:
(1) A prescription drug that is in unit-of-use packaging for which
synchronization is not possible.
(2) A prescription drug that is subject to quantity limits or
other utilization management controls that are inconsistent with the
synchronization program, including, but not limited to, controlled
substance prescribing and special dispensing requirements or
guidelines intended to prevent misuse or abuse.
(3) A prescription drug that the patient has been taking for less
than 90 consecutive calendar days.
(e) The coverage required by this section may be limited by
formulary restrictions applied to a prescription drug by a health
care service plan.
SEC. 2. Section 10123.208 is added to the Insurance Code, to read:
10123.208. (a) A health insurance policy issued, amended, or
renewed on or after January 1, 2017, that provides coverage for
prescription drug benefits shall implement a synchronization
policy program for the dispensing of
prescription drugs to the policy's insured
insureds .
(b) For purposes of this section, "synchronization policy" means a
procedure for aligning the refill dates of an insured's prescription
drugs so that prescriptions that are refilled at the same frequency
may be refilled concurrently.
(b) In implementing the synchronization program pursuant to this
section, all of the following shall apply:
(1) The insurer shall not deny coverage for a prescription drug
covered by the health insurance policy that is dispensed by a network
pharmacy for less than the standard refill amount for the purpose of
improving medication adherence or if the insured agrees that
synchronizing his or her medications is in his or her best interest.
(2) The insurer shall accept early refill and short-fill requests
for prescription drugs using the submission clarification and message
codes adopted by the National Council for Prescription Drug Programs
or alternative codes provided by the insurer.
(3) The insurer may apply a prorated daily cost-sharing rate for
maintenance prescription drugs that are dispensed by a network
pharmacy for the purpose of synchronizing the insured's medications.
(4) The insurer may impose a limit on the number of
synchronization attempts in a contract year. The limit may be
established by the insurer in an amount of not less than four
attempts per year.
(c) For purposes of this section, "synchronization program" means
a procedure for aligning the refill dates of an insured's
prescription drugs that are being dispensed by a single retail
network pharmacy so that prescriptions that are refilled at the same
frequency may be refilled concurrently for the purpose of improving
medication adherence or if it is in the best interest of the insured.
(d) This section does not apply to any of the following:
(1) A prescription drug that is in unit-of-use packaging for which
synchronization is not possible.
(2) A prescription drug that is subject to quantity limits or
other utilization management controls that are inconsistent with the
synchronization program, including, but not limited to, controlled
substance prescribing and special dispensing requirements or
guidelines intended to prevent misuse or abuse.
(3) A prescription drug that the patient has been taking for less
than 90 consecutive calendar days.
(e) The coverage required by this section may be limited by
formulary restrictions applied to a prescription drug by a health
insurer.
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.
