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

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

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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-Introduced.html

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BILL NUMBER: AB 374	INTRODUCED
	BILL TEXT


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, as introduced, 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 that provides
prescription drug benefits to maintain an expeditious process by
which prescribing providers, as described, may obtain authorization
for a medically necessary nonformulary prescription drug, according
to certain procedures.
   This bill would prohibit a health care service plan or health
insurer that provides medication pursuant to a step therapy or
first-fail requirement from applying that requirement to a patient
if, in the professional judgment of the prescribing physician, the
step therapy or first-fail requirement would be medically
inappropriate for that patient.
   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.
   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 1367.244 is added to the Health and Safety
Code, to read:
   1367.244.  A health care service plan that provides coverage for
medications pursuant to a step therapy or first-fail protocol shall
not apply that requirement to a patient if, in the professional
judgment of the prescribing physician, the step therapy or first-fail
requirement would be medically inappropriate for that patient.
  SEC. 2.  Section 10123.197 is added to the Health and Safety Code,
to read:
   10123.197.  A health insurer that provides coverage for
medications pursuant to a step therapy or first-fail protocol shall
not apply that requirement to a patient if, in the professional
judgment of the prescribing physician, the step therapy or first-fail
requirement would be medically inappropriate for that patient.
   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.