BILL NUMBER: SB 1010 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 31, 2016
AMENDED IN SENATE MARCH 30, 2016
INTRODUCED BY Senator Hernandez
FEBRUARY 11, 2016
An act to amend Section 1385.045 of, to add Section 1367.245 to,
and to add Chapter 9 (commencing with Section 127675) to Part 2 of
Division 107 of of, the Health and
Safety Code, and to amend Section 10181.45 of, and to add Section
10123.204 to, the Insurance Code, relating to health care.
LEGISLATIVE COUNSEL'S DIGEST
SB 1010, as amended, Hernandez. Health care: prescription drug
costs.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975
(Knox-Keene Act), provides for the licensure and regulation of health
care service plans by the Department of Managed Health Care (DMHC)
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 (DOI). Existing law requires health care service plans and
health insurers to file specified rate information with DMHC or DOI,
as applicable, for health care service plan contracts or health
insurance policies in the individual or small group markets and for
health care service plan contracts and health insurance policies in
the large group market.
This bill would require health care service plans or health
insurers that file the above-described rate information to report to
DMHC or DOI, on a date no later than the reporting of the rate
information, specified cost information regarding covered
prescription drugs, including generic drugs, brand name drugs,
specialty drugs, and prescription drugs provided in an
outpatient setting or sold in a retail and specialty
drugs provided in an outpatient setting. The information
reported would include, but not be limited to, the 25 most frequently
prescribed drugs and the average wholesale price for each
drug and the 25 most costly drugs by total plan or insurer spending
and the average wholesale price for each drug. and the
25 most costly drugs by total plan or insurer spending. DMHC
and DOI would be required to compile the reported information into a
consumer-friendly report report for the
public and legislators that demonstrates the overall impact of
drug costs on health care premiums and publish the reports on their
Internet Web sites by January 1 October 1
of each year. Except for the report, DMHC and DOI would be
required to keep confidential all information provided pursuant to
these provisions.
Because a willful violation of the Knox-Keene Act is a crime, this
bill would impose a state-mandated local program.
This bill would require a manufacturer of a branded prescription
drug to notify in writing state purchasers, health care
service plans, health insurers, pharmacy benefit managers,
and the chairs of specified Senate and Assembly committees if it is
increasing the wholesale acquisition cost of the drug by more than
10% or by more than $10,000 during any 12-month
period or if it intends to introduce to market a prescription drug
that has a wholesale acquisition cost of $10,000 or more annually or
per course of treatment. period. The bill would
require a manufacturer of a generic prescription drug with a
specified price wholesale acquisition cost
to notify state purchasers, health care service plans, health
insurers, pharmacy benefit managers, and the chairs of
specified Senate and Assembly committees if it is increasing the
wholesale acquisition cost of the drug by more than 10%
25% during any 12-month period. The bill
would require a manufacturer of a prescription drug to notify in
writing, within 3 days of approval by the federal Food and Drug
Administration, state purchasers, health care service plans, health
insurers, pharmacy benefit managers, and the chairs of specified
Senate and Assembly committees if it is introducing a new
prescription drug to market at a wholesale acquisition cost of
$10,000 or more annually or per course of treatment. The bill
would require a manufacturer, within 30 days of notification of a
price increase, or notification of the introduction to
market of a prescription drug that has a wholesale acquisition cost
of $10,000 or more annually or per course of treatment, to report
specified information regarding the drug price to each state
purchaser, health care service plan, and health
insurer, or pharmacy benefit manager and would require a
manufacturer who fails to provide the required information within the
30 days to be subject to a civil penalty of $1,000 per day. The bill
would also require the Legislature to conduct an annual public
hearing regarding the price increases and information
reported, aggregate trends in prescription drug
pricing, as prescribed. Except for the hearing, the
Legislature would be required to keep confidential all information
provided pursuant to these provisions.
Existing law requires, for large group health care service plan
contracts and health insurance policies, each health care service
plan or health insurer to file with DMHC or DOI the weighted average
rate increase for all large group benefit designs during the 12-month
period ending January 1 of the following calendar year, and to also
disclose specified information for the aggregate rate information for
the large group market.
This bill would add to that disclosure of information for the
aggregate rate information for the large group market, the
requirement for health care service plans or health insurers to
disclose specified cost information regarding covered prescription
drugs, including generic drugs, drugs but
excluding generic specialty drugs, brand name drugs excluding
specialty drugs, and specialty drugs dispensed at a pharmacy, network
pharmacy, or mail order pharmacy for outpatient use.
Existing constitutional provisions require that a statute that
limits the right of access to the meetings of public bodies or the
writings of public officials and agencies be adopted with findings
demonstrating the interest protected by the limitation and the need
for protecting that interest.
This bill would make legislative findings to that effect.
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 1367.245 is added to the Health and Safety
Code, immediately preceding Section 1367.25, to read:
1367.245. (a) (1) A health care service plan that reports rate
information pursuant to Section 1385.03 or 1385.045 shall report the
information described in paragraph (2) to the department on a date no
later than it reports the rate information.
(2) For all covered prescription drugs, including generic drugs,
brand name drugs, specialty drugs, and prescription drugs
provided in an outpatient setting or sold in a retail
and specialty drugs provided in an outpatient setting, all of
the following shall be reported:
(A) The 25 most frequently prescribed drugs and the
average wholesale price for each drug. drugs.
(B) The 25 most costly drugs by total plan spending and
the average wholesale price for each drug. spending.
(C) The 25 drugs with the highest year-over-year increase
and the average wholesale price for each drug. in
spending.
(b) The department shall compile the information reported pursuant
to subdivision (a) into a consumer-friendly report
report for the public and legislators that
demonstrates the overall impact of drug costs on health care
premiums. The data in the report shall be aggregated and shall not
reveal information specific to individual health care service plans.
(c) For the purposes of this section, a "specialty drug" is one
that exceeds the threshold for a specialty drug under the Medicare
Part D program (Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173)).
(d) By January 1 October 1 of each
year, the department shall publish on its Internet Web site the
report required pursuant to subdivision (b).
(e) After the report required in subdivision (b) is released, the
department shall include the report as part of the public meeting
required pursuant to subdivision (b) of Section 1385.045.
(f) Except for the report required pursuant to subdivision (b),
the department shall keep confidential all of the information
provided to the department pursuant to this section, and that
information shall be exempt from disclosure under the California
Public Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code).
SEC. 2. Section 1385.045 of the Health and Safety Code is amended
to read:
1385.045. (a) For large group health care service plan contracts,
each health plan shall file with the department the weighted average
rate increase for all large group benefit designs during the
12-month period ending January 1 of the following calendar year. The
average shall be weighted by the number of enrollees in each large
group benefit design in the plan's large group market and adjusted to
the most commonly sold large group benefit design by enrollment
during the 12-month period. For the purposes of this section, the
large group benefit design includes, but is not limited to, benefits
such as basic health care services and prescription drugs. The large
group benefit design shall not include cost sharing, including, but
not limited to, deductibles, copays, and coinsurance.
(b) (1) A plan shall also submit any other information required
pursuant to any regulation adopted by the department to comply with
this article.
(2) The department shall conduct an annual public meeting
regarding large group rates within three months of posting the
aggregate information described in this section in order to permit a
public discussion of the reasons for the changes in the rates,
benefits, and cost sharing in the large group market. The meeting
shall be held in either the Los Angeles area or the San Francisco Bay
area.
(c) A health care service plan subject to subdivision (a) shall
also disclose the following for the aggregate rate information for
the large group market submitted under this section:
(1) For rates effective during the 12-month period ending January
1 of the following year, number and percentage of rate changes
reviewed by the following:
(A) Plan year.
(B) Segment type, including whether the rate is community rated,
in whole or in part.
(C) Product type.
(D) Number of enrollees.
(E) The number of products sold that have materially different
benefits, cost sharing, or other elements of benefit design.
(2) For rates effective during the 12-month period ending January
1 of the following year, any factors affecting the base rate, and the
actuarial basis for those factors, including all of the following:
(A) Geographic region.
(B) Age, including age rating factors.
(C) Occupation.
(D) Industry.
(E) Health status factors, including, but not limited to,
experience and utilization.
(F) Employee, and employee and dependents, including a description
of the family composition used.
(G) Enrollees' share of premiums.
(H) Enrollees' cost sharing.
(I) Covered benefits in addition to basic health care services, as
defined in Section 1345, and other benefits mandated under this
article.
(J) Which market segment, if any, is fully experience rated and
which market segment, if any, is in part experience rated and in part
community rated.
(K) Any other factor that affects the rate that is not otherwise
specified.
(3) (A) The plan's overall annual medical trend factor assumptions
for all benefits and by aggregate benefit category, including
hospital inpatient, hospital outpatient, physician services,
prescription drugs and other ancillary services, laboratory, and
radiology for the applicable 12-month period ending January 1 of the
following year. A health plan that exclusively contracts with no more
than two medical groups in the state to provide or arrange for
professional medical services for the enrollees of the plan shall
instead disclose the amount of its actual trend experience for the
prior contract year by aggregate benefit category, using benefit
categories, to the maximum extent possible, that are the same as, or
similar to, those used by other plans.
(B) The amount of the projected trend separately attributable to
the use of services, price inflation, and fees and risk for annual
plan contract trends by aggregate benefit category, including
hospital inpatient, hospital outpatient, physician services,
prescription drugs and other ancillary services, laboratory, and
radiology. A health plan that exclusively contracts with no more than
two medical groups in the state to provide or arrange for
professional medical services for the enrollees of the plan shall
instead disclose the amount of its actual trend experience for the
prior contract year by aggregate benefit category, using benefit
categories that are, to the maximum extent possible, the same or
similar to those used by other plans.
(C) A comparison of the aggregate per enrollee per month costs and
rate of changes over the last five years for each of the following:
(i) Premiums.
(ii) Claims costs, if any.
(iii) Administrative expenses.
(iv) Taxes and fees.
(D) Any changes in enrollee cost sharing over the prior year
associated with the submitted rate information, including both of the
following:
(i) Actual copays, coinsurance, deductibles, annual out
of pocket out-of-pocket maximums, and any other
cost sharing by the benefit categories determined by the department.
(ii) Any aggregate changes in enrollee cost sharing over the prior
years as measured by the weighted average actuarial value, weighted
by the number of enrollees.
(E) Any changes in enrollee benefits over the prior year,
including a description of benefits added or eliminated, as well as
any aggregate changes, as measured as a percentage of the aggregate
claims costs, listed by the categories determined by the department.
(F) Any cost containment and quality improvement efforts since the
plan's prior year's information pursuant to this section for the
same category of health benefit plan. To the extent possible, the
plan shall describe any significant new health care cost containment
and quality improvement efforts and provide an estimate of potential
savings together with an estimated cost or savings for the projection
period.
(G) The number of products covered by the information that
incurred the excise tax paid by the health plan.
(4) (A) For covered prescription drugs, including generic
drugs, drugs but excluding specialty generic drugs,
brand name drugs excluding specialty drugs, and specialty drugs
dispensed at a plan pharmacy, network pharmacy, or mail order
pharmacy for outpatient use all of the following shall be disclosed:
(i) The percentage of the premium attributable to prescription
drug costs for the prior year for each category of prescription
drugs. drugs as defined in subparagraph (A).
(ii) The year-over-year increase in the percentage of the
premium attributable to each category of prescription drugs.
increase, as a percentage, in total spending for each
category of prescription drugs as defined in subparagraph (A).
(iii) The year-over-year increase in per member, per month costs
for drug prices compared to other components of the health care
premium.
(iv) The specialty tier formulary list.
(B) The plan shall include the percentage of the premium
attributable to prescription drugs administered in a doctor's office
that are part of covered under the
medical benefit as separate from the pharmacy benefit, if available.
(d) The information required pursuant to this section shall be
submitted to the department on or before October 1, 2016, and on or
before October 1 annually thereafter. Information submitted pursuant
to this section is subject to Section 1385.07.
(e) For the purposes of this section, a "specialty drug" is one
that exceeds the threshold for a specialty drug under the Medicare
Part D program (Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173)).
SEC. 3. Chapter 9 (commencing with Section 127675) is added to
Part 2 of Division 107 of the Health and Safety Code, to read:
CHAPTER 9. PRESCRIPTION DRUG PRICING FOR STATE
PURCHASERS
127675. (a) This chapter shall apply to any manufacturer of a
prescription drug that is purchased or reimbursed by any of the
following:
(1) A state purchaser in California, including, but not limited
to, the Public Employees' Retirement System, the State Department of
Health Care Services, the Department of General Services, and the
Department of Corrections and Rehabilitation, or an entity acting on
behalf of a state purchaser.
(2) A health care service plan licensed pursuant to Section 1353.
(3) A health insurer holding a valid outstanding certificate of
authority from the Insurance Commissioner.
(4) A pharmacy benefit manager as defined in subdivision (j) of
Section 4430 of the Business and Professions Code.
(b) (1) A manufacturer of a branded prescription drug shall notify
each state purchaser, health care service plan, or
health insurer insurer, or pharmacy
benefit manager if it is increasing the wholesale acquisition
cost of a prescription drug by more than 10 percent or by more
than ten thousand dollars ($10,000) during any 12-month
period or if it intends to introduce to market a
prescription drug that has a wholesale acquisition cost of ten
thousand dollars ($10,000) or more annually or per course of
treatment. period. The notice shall be provided
in writing at least 60 days prior to the planned effective date of
the increase. A copy of the notice shall be provided concurrently to
the Chairs of the Senate Committee on Appropriations, the Senate
Committee on Budget and Fiscal Review, the Assembly Committee on
Appropriations, and the Assembly Committee on Budget.
(2) A manufacturer of a generic prescription drug with a
price wholesale acquisition cost of one hundred
dollars ($100) or more per 30-day month
supply shall notify a state purchaser, health care service plan,
or health insurer insurer,
or pharmacy benefit manager if it is increasing the wholesale
acquisition cost of the prescription drug by more than 10
25 percent during a 12-month period. The notice
shall be provided in writing at least 60 days prior to the planned
effective date of the increase. A copy of the notice shall be
provided concurrently to the Chairs of the Senate Committee on
Appropriations, the Senate Committee on Budget and Fiscal Review, the
Assembly Committee on Appropriations, and the Assembly Committee on
Budget.
(3) (A) Within 30 days of
notification of a price increase, or of the introduction to
market of a prescription drug that has a wholesale acquisition cost
of ten thousand dollars ($10,000) or more annually or per course of
treatment, increase under paragraph (1) or (2),
a manufacturer shall report all of the following information to each
state purchaser, health care service plan, or health
insurer: health insurer, or pharmacy benefit manager:
(i)
(A) A justification for the proposed increase
in the price of the drug, including all information and supporting
documentation as to why the increase is justified.
price increase. The manufacturer may limit the information
in the justification to that which is publicly available.
(ii) The total dollar amount of public funding received by the
manufacturer for the development and marketing, including, but not
limited to, state and federal tax credits, grants, and all other
public subsidies.
(iii)
(B) The expected
previous year's marketing budget for the drug.
(iv)
(C) The date the drug was purchased if it
and price of acquisition if the drug was not
developed by the manufacturer.
(v)
(D) A schedule of past price
increases for the drug. drug for the previous
five years.
(4) (A) A manufacturer of a prescription drug shall notify in
writing each state purchaser, health care service plan, health
insurer, or pharmacy benefit manager if it is introducing a new
prescription drug to market at a wholesale acquisition cost of ten
thousand dollars ($10,000) or more annually or per course of
treatment. The notice shall be provided in writing within three days
of the federal Food and Drug Administration approval. A copy of the
notice shall be provided concurrently to the Chairs of the Senate
Committee on Appropriations, the Senate Committee on Budget and
Fiscal Review, the Assembly Committee on Appropriations, and the
Assembly Committee on Budget.
(B) Within 30 days of notification of a new drug under this
paragraph, a manufacturer shall report all of the following
information to each state purchaser, health care service plan, health
insurer, or pharmacy benefit manager:
(i) A justification for the introductory price. The manufacturer
may limit the contents of the justification to publicly available
information.
(ii) The expected marketing budget for the drug.
(iii) The date and price of acquisition if the drug was not
developed by the manufacturer.
(B)
(5) Failure to report the information required
pursuant to paragraph (3) or subparagraph (B) of paragraph (4)
to state purchasers, health care service plans, or
health insurers insurers, or pharmacy
benefit managers shall result in a civil penalty of one
thousand dollars ($1,000) per day for every day after the 30-day
notification period.
(c) The Legislature shall conduct an annual public hearing
regarding the price increases and information reported
pursuant to this section. The hearing shall provide for public
discussion of the reasons for the price increases, emerging trends,
decreases in drug prices, and the impact on health care affordability
and premiums. on aggregate trends in prescription
drug pricing. The hearing shall provide for public discussion of
overall price increases, emerging trends, decreases in drug spending,
and the impact of prescription drug spending on health care
affordability and premiums.
(d) Except for the hearing required pursuant to subdivision (c),
the Legislature shall keep confidential all of the information
provided to the Legislature pursuant to this section, and that
information shall be exempt from disclosure under the California
Public Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code).
(d)
(e) This chapter shall not restrict the legal ability
of a pharmaceutical manufacturer to change prices as permitted under
federal law.
SEC. 4. Section 10123.204 is added to the Insurance Code,
immediately preceding Section 10123.206, to read:
10123.204. (a) (1) A health insurer that reports rate information
pursuant to Section 10181.3 or 10181.45 shall report the information
described in paragraph (2) to the department on a date no later than
it reports the rate information.
(2) For all covered prescription drugs, including generic drugs,
brand name drugs, specialty drugs, and prescription drugs
provided in an outpatient setting or sold in a retail
and specialty drugs provided in an outpatient setting, all of
the following shall be reported:
(A) The 25 most frequently prescribed drugs and the
average wholesale price for each drug. drugs.
(B) The 25 most costly drugs by total insurer spending
and the average wholesale price for each drug.
spending.
(C) The 25 drugs with the highest year-over-year increase
and the average wholesale price for each drug. in
spending.
(b) The department shall compile the information reported pursuant
to subdivision (a) into a consumer-friendly report
report for the public and legislators that
demonstrates the overall impact of drug costs on health care
premiums. The data in the report shall be aggregated and shall not
reveal information specific to individual health insurers.
(c) For the purposes of this section, a "specialty drug" is one
that exceeds the threshold for a specialty drug under the Medicare
Part D program (Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173)).
(d) By January 1 October 1 of each
year, the department shall publish on its Internet Web site the
report required pursuant to subdivision (b).
(e) After the report required in subdivision (b) is released, the
department shall include the report as part of the public meeting
required pursuant to subdivision (b) of Section 10181.45.
(f) Except for the report required pursuant to subdivision (b),
the department shall keep confidential all of the information
provided to the department pursuant to this section, and that
information shall be exempt from disclosure under the California
Public Records Act (Chapter 3.5 (commencing with Section 6250) of
Division 7 of Title 1 of the Government Code).
SEC. 5. Section 10181.45 of the Insurance Code is amended to read:
10181.45. (a) For large group health insurance policies, each
health insurer shall file with the department the weighted average
rate increase for all large group benefit designs during the 12-month
period ending January 1 of the following calendar year. The average
shall be weighted by the number of insureds in each large group
benefit design in the insurer's large group market and adjusted to
the most commonly sold large group benefit design by enrollment
during the 12-month period. For the purposes of this section, the
large group benefit design includes, but is not limited to, benefits
such as basic health care services and prescription drugs. The large
group benefit design shall not include cost sharing, including, but
not limited to, deductibles, copays, and coinsurance.
(b) (1) A health insurer shall also submit any other information
required pursuant to any regulation adopted by the department to
comply with this article.
(2) The department shall conduct an annual public meeting
regarding large group rates within three months of posting the
aggregate information described in this section in order to permit a
public discussion of the reasons for the changes in the rates,
benefits, and cost sharing in the large group market. The meeting
shall be held in either the Los Angeles area or the San Francisco Bay
area.
(c) A health insurer subject to subdivision (a) shall also
disclose the following for the aggregate rate information for the
large group market submitted under this section:
(1) For rates effective during the 12-month period ending January
1 of the following year, number and percentage of rate changes
reviewed by the following:
(A) Plan year.
(B) Segment type, including whether the rate is community rated,
in whole or in part.
(C) Product type.
(D) Number of insureds.
(E) The number of products sold that have materially different
benefits, cost sharing, or other elements of benefit design.
(2) For rates effective during the 12-month period ending January
1 of the following year, any factors affecting the base rate, and the
actuarial basis for those factors, including all of the following:
(A) Geographic region.
(B) Age, including age rating factors.
(C) Occupation.
(D) Industry.
(E) Health status factors, including, but not limited to,
experience and utilization.
(F) Employee, and employee and dependents, including a description
of the family composition used.
(G) Insureds' share of premiums.
(H) Insureds' cost sharing.
(I) Covered benefits in addition to basic health care services, as
defined in Section 1345 of the Health and Safety Code, and other
benefits mandated under this article.
(J) Which market segment, if any, is fully experience rated and
which market segment, if any, is in part experience rated and in part
community rated.
(K) Any other factor that affects the rate that is not otherwise
specified.
(3) (A) The insurer's overall annual medical trend factor
assumptions for all benefits and by aggregate benefit category,
including hospital inpatient, hospital outpatient, physician
services, prescription drugs and other ancillary services,
laboratory, and radiology for the applicable 12-month period ending
January 1 of the following year. A health insurer that exclusively
contracts with no more than two medical groups in the state to
provide or arrange for professional medical services for the health
insurer's insureds shall instead disclose the amount of its actual
trend experience for the prior contract year by aggregate benefit
category, using benefit categories, to the maximum extent possible,
that are the same or similar to those used by other insurers.
(B) The amount of the projected trend separately attributable to
the use of services, price inflation, and fees and risk for annual
policy trends by aggregate benefit category, including hospital
inpatient, hospital outpatient, physician services, prescription
drugs and other ancillary services, laboratory, and radiology. A
health insurer that exclusively contracts with no more than two
medical groups in the state to provide or arrange for professional
medical services for the insureds shall instead disclose the amount
of its actual trend experience for the prior contract year by
aggregate benefit category, using benefit categories that are, to the
maximum extent possible, the same or similar to those used by other
insurers.
(C) A comparison of the aggregate per insured per month costs and
rate of changes over the last five years for each of the following:
(i) Premiums.
(ii) Claims costs, if any.
(iii) Administrative expenses.
(iv) Taxes and fees.
(D) Any changes in insured cost sharing over the prior year
associated with the submitted rate information, including both of the
following:
(i) Actual copays, coinsurance, deductibles, annual out
of pocket out-of-pocket maximums, and any other
cost sharing by the benefit categories determined by the department.
(ii) Any aggregate changes in insured cost sharing over the prior
years as measured by the weighted average actuarial value, weighted
by the number of insureds.
(E) Any changes in insured benefits over the prior year, including
a description of benefits added or eliminated as well as any
aggregate changes as measured as a percentage of the aggregate claims
costs, listed by the categories determined by the department.
(F) Any cost containment and quality improvement efforts made
since the insurer's prior year's information pursuant to this section
for the same category of health insurer. To the extent possible, the
insurer shall describe any significant new health care cost
containment and quality improvement efforts and provide an estimate
of potential savings together with an estimated cost or savings for
the projection period.
(G) The number of products covered by the information that
incurred the excise tax paid by the health insurer.
(4) (A) For covered prescription drugs, including generic
drugs, drugs but excluding specialty generic drugs,
brand name drugs excluding specialty drugs, and specialty drugs
dispensed at a pharmacy, network pharmacy, or mail order pharmacy
for outpatient use all of the following shall be disclosed:
(i) The percentage of the premium attributable to prescription
drug costs for the prior year for each category of prescription
drugs. drugs as defined in subparagraph (A).
(ii) The year-over-year increase in the percentage of the
premium attributable to each category of prescription drugs.
increase, as a percentage, in total spending for each
category of prescription drugs as defined in subparagraph (A).
(iii) The year-over-year increase in per member, per month costs
for drug prices compared to other components of the health care
premium.
(iv) The specialty tier formulary list.
(B) The insurer shall include the percentage of the premium
attributable to prescription drugs administered in a doctor's office
that are part of
covered under the medical benefit as separate
from the pharmacy benefit, if available.
(d) The information required pursuant to this section shall be
submitted to the department on or before October 1, 2016, and on or
before October 1 annually thereafter. Information submitted pursuant
to this section is subject to Section 10181.7.
(e) For the purposes of this section, a "specialty drug" is one
that exceeds the threshold for a specialty drug under the Medicare
Part D program (Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173)).
SEC. 6. The Legislature finds and declares that Sections
1 and 1, 3, and 4 of this act, which add
Section 1367.245 Sections 1367.245 and 127675
to the Health and Safety Code and Section 10123.204 to the
Insurance Code, impose a limitation on the public's right of access
to the meetings of public bodies or the writings of public officials
and agencies within the meaning of Section 3 of Article I of the
California Constitution. Pursuant to that constitutional provision,
the Legislature makes the following findings to demonstrate the
interest protected by this limitation and the need for protecting
that interest:
In order to protect proprietary, confidential information reported
by prescription drug manufacturers, health care service plans, and
health insurers, and to protect the integrity of the competitive
market, it is necessary that this act limit the public's right of
access to that information.
SEC. 7. 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.