Bill Text: CA AB374 | 2015-2016 | Regular Session | Chaptered

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Bill Title: Health care coverage: prescription drugs.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2015-10-08 - Chaptered by Secretary of State - Chapter 621, Statutes of 2015. [AB374 Detail]

Download: California-2015-AB374-Chaptered.html

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BILL NUMBER: AB 374	CHAPTERED
	BILL TEXT

	CHAPTER  621
	FILED WITH SECRETARY OF STATE  OCTOBER 8, 2015
	APPROVED BY GOVERNOR  OCTOBER 8, 2015
	PASSED THE SENATE  SEPTEMBER 8, 2015
	PASSED THE ASSEMBLY  SEPTEMBER 9, 2015
	AMENDED IN SENATE  SEPTEMBER 2, 2015
	AMENDED IN SENATE  SEPTEMBER 1, 2015
	AMENDED IN SENATE  JULY 16, 2015
	AMENDED IN SENATE  JUNE 19, 2015
	AMENDED IN ASSEMBLY  APRIL 30, 2015
	AMENDED IN ASSEMBLY  MARCH 2, 2015

INTRODUCED BY   Assembly Member Nazarian

                        FEBRUARY 17, 2015

   An act to add Section 1367.244 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 374, Nazarian. Health care coverage: prescription drugs.
   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 that act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law imposes various requirements and restrictions on health
care service plans and health insurers, including, among other
things, requiring a health care service plan or health insurer that
provides prescription drug benefits to utilize a specified uniform
prior authorization form or electronic authorization process when
requiring prior authorization for prescription drug benefits.
   This bill would authorize a request for an exception to a health
care service plan's or health insurer's step therapy process for
prescription drugs to be submitted in the same manner as a request
for prior authorization for prescription drugs, and would require the
plan or insurer to treat, and respond to, the request in the same
manner as a request for prior authorization for prescription drugs.
   The bill would require the Department of Managed Health Care and
the Department of Insurance to include a provision for step therapy
exception requests in the uniform prior authorization form specified
above.
   Because a willful violation of these 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.


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

  SECTION 1.  Section 1367.244 is added to the Health and Safety
Code, to read:
   1367.244.  (a) A request for an exception to a health care service
plan's step therapy process for prescription drugs may be submitted
in the same manner as a request for prior authorization for
prescription drugs pursuant to Section 1367.241, and shall be treated
in the same manner, and shall be responded to by the health care
service plan in the same manner, as a request for prior authorization
for prescription drugs.
   (b) The department and the Department of Insurance shall include a
provision for step therapy exception requests in the uniform prior
authorization form developed pursuant to subdivision (c) of Section
1367.241.
  SEC. 2.  Section 10123.197 is added to the Insurance Code, to read:

   10123.197.  (a) A request for an exception to a health insurer's
step therapy process for prescription drugs may be submitted in the
same manner as a request for prior authorization for prescription
drugs pursuant to Section 10123.191, and shall be treated in the same
manner, and shall be responded to by the health insurer in the same
manner, as a request for prior authorization for prescription drugs.
   (b) The department and the Department of Managed Health Care shall
include a provision for step therapy exception requests in the
uniform prior authorization form developed pursuant to subdivision
(c) of Section 10123.191.
  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.