Bill Text: CA AB2418 | 2013-2014 | Regular Session | Enrolled
Bill Title: Health care coverage: prescription drugs: refills.
Spectrum: Moderate Partisan Bill (Democrat 5-1)
Status: (Vetoed) 2014-09-25 - Vetoed by Governor. [AB2418 Detail]
Download: California-2013-AB2418-Enrolled.html
BILL NUMBER: AB 2418 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 21, 2014
PASSED THE ASSEMBLY AUGUST 25, 2014
AMENDED IN SENATE AUGUST 19, 2014
AMENDED IN SENATE JULY 3, 2014
AMENDED IN SENATE JULY 1, 2014
AMENDED IN ASSEMBLY MAY 27, 2014
AMENDED IN ASSEMBLY MAY 7, 2014
AMENDED IN ASSEMBLY APRIL 23, 2014
INTRODUCED BY Assembly Members Bonilla and Skinner
(Coauthors: Assembly Members Bonta, Maienschein, Nazarian, and
Nestande)
FEBRUARY 21, 2014
An act to add Sections 1367.248 and 1367.249 to the Health and
Safety Code, and to add Sections 10123.208 and 10123.209 to the
Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2418, Bonilla. 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, 2016, that provides coverage for prescription drug
benefits to permit and apply a prorated daily cost-sharing rate to
refills of prescriptions that are dispensed by a participating
pharmacy for less than the standard refill amount if the prescriber
or pharmacist indicates that the refill is in the best interest of
the enrollee or insured and is for the purpose of synchronizing the
refill dates of the enrollee's or insured's medications, provided
that certain requirements are satisfied. The bill would also require
a health care service plan contract or health insurance policy
issued, amended, or renewed on or after January 1, 2016, that
provides coverage for prescription drug benefits to allow for the
early refill of covered topical ophthalmic products at 70% of the
predicted days of use. 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.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature hereby finds and declares all of the
following:
(a) As many as 75 percent of patients do not take their
medications as prescribed. Poor adherence to prescribed treatments
poses serious health risks to nonadhering patients, particularly
those with chronic diseases.
(b) Poor adherence to prescribed treatments leads to unnecessary
disease progression, avoidable utilization of inpatient and
outpatient medical care, higher mortality rates, and increased
medical spending. According to the New England Healthcare Institute,
poor adherence to medication results in $100 billion in excess
hospital visits and a total of $290 billion in avoidable medical
spending each year -- 13 percent of all health care expenditures in
the United States. Adherence to prescription medication prevents
these unnecessary complications and is a cost-effective and simple
tool in the treatment of health conditions.
(c) Given the evidence showing benefits to patients, the federal
Centers for Medicare and Medicaid Services requires Medicare Part D
plans to allow for the synchronization of refill dates for patients
with multiple prescriptions and recommends that Part D plans
authorize early refills of topical ophthalmic products at 70 percent
of the predicted days of use.
(d) It is the intent of the Legislature to enact legislation that
promotes policies designed to improve patient medication adherence.
SEC. 2. 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, 2016, that provides
coverage for prescription drug benefits shall permit and apply a
prorated daily cost-sharing rate to the refills of prescriptions that
are dispensed by a participating pharmacy for less than the standard
refill amount if the prescriber or pharmacist indicates that the
refill for less than the standard amount is in the best interest of
the enrollee and is for the purpose of synchronizing the refill dates
of the enrollee's medications and all of the following apply:
(1) The prescription drugs being synchronized are covered and
authorized by the health care service plan contract.
(2) The prescription drugs being refilled for less than the
standard amount are not subject to quantity limits or other
utilization management controls that are inconsistent with the
synchronization plan, including, but not limited to, controlled
substance prescribing and dispensing guidelines intended to prevent
misuse or abuse.
(3) The prescription drugs being synchronized are dispensed by a
single participating pharmacy.
(4) The patient has completed at least 90 consecutive days on the
prescription drugs being synchronized.
(5) The prescription drugs being refilled for less than the
standard amount are of a formulation that can be effectively split
over the required short fill period to achieve synchronization.
(6) The prescriber has not done either of the following with
respect to the prescription drugs being refilled for less than the
standard amount:
(A) Indicated, either orally or in his or her own handwriting, "No
change to quantity," or words of similar meaning.
(B) Checked a box on the prescription marked "No change to
quantity," and personally initialed the box or checkmark.
(b) This section shall not apply to a drug that is not available
at a participating community pharmacy due to any of the following:
(1) An industry shortage listed on the Current Drug Shortages
Index maintained by the federal Food and Drug Administration (FDA).
(2) A manufacturer's instructions or restrictions.
(3) Any risk evaluation and management strategy approved by the
FDA.
(4) A special shortage affecting the plan's network of
participating pharmacies.
(c) Nothing in this section shall be construed to establish a new
or mandated benefit or to prevent the application of deductible or
copayment provisions in a plan contract.
SEC. 3. Section 1367.249 is added to the Health and Safety Code,
to read:
1367.249. (a) A health care service plan contract issued,
amended, or renewed on or after January 1, 2016, that provides
coverage for prescription drug benefits shall allow for early refills
of covered topical ophthalmic products at 70 percent of the
predicted days of use.
(b) Nothing in this section shall be construed to establish a new
mandated benefit or to prevent the application of deductible or
copayment provisions in a plan contract.
SEC. 4. 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, 2016, that provides coverage for
prescription drug benefits shall permit and apply a prorated daily
cost-sharing rate to the refills of prescriptions that are dispensed
by a participating pharmacy for less than the standard refill amount
if the prescriber or pharmacist indicates that the refill for less
than the standard amount is in the best interest of the insured and
is for the purpose of synchronizing the refill dates of the insured's
medications and all of the following apply:
(1) The prescription drugs being synchronized are covered and
authorized by the health insurance policy.
(2) The prescription drugs being refilled for less than the
standard amount are not subject to quantity limits or other
utilization management controls that are inconsistent with the
synchronization plan, including, but not limited to, controlled
substance prescribing and dispensing guidelines intended to prevent
misuse or abuse.
(3) The prescription drugs being synchronized are dispensed by a
single participating pharmacy.
(4) The insured has completed at least 90 consecutive days on the
prescription drugs being synchronized.
(5) The prescription drugs being refilled for less than the
standard amount are of a formulation that can be effectively split
over the required short fill period to achieve synchronization.
(6) The prescriber has not done either of the following with
respect to the prescription drugs being refilled for less than the
standard amount:
(A) Indicated, either orally or in his or her own handwriting, "No
change to quantity," or words of similar meaning.
(B) Checked a box on the prescription marked "No change to
quantity," and personally initialed the box or checkmark.
(b) This section shall not apply to a drug that is not available
at a participating community pharmacy due to any of the following:
(1) An industry shortage listed on the Current Drug Shortages
Index maintained by the federal Food and Drug Administration (FDA).
(2) A manufacturer's instructions or restrictions.
(3) Any risk evaluation and management strategy approved by the
FDA.
(4) A special shortage affecting the insurer's network of
participating pharmacies.
(c) Nothing in this section shall be construed to establish a new
or mandated benefit or to prevent the application of deductible or
copayment provisions in a policy.
SEC. 5. Section 10123.209 is added to the Insurance Code, to read:
10123.209. (a) A health insurance policy issued, amended, or
renewed on or after January 1, 2016, that provides coverage for
prescription drug benefits shall allow for early refills of covered
topical opthalmic products at 70 percent of the predicted days of
use.
(b) Nothing in this section shall be construed to establish a new
mandated benefit or to prevent the application of deductible or
copayment provisions in a policy.
SEC. 6. 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.
