BILL ANALYSIS
SB 1096
Page 1
Date of Hearing: June 17, 2008
ASSEMBLY COMMITTEE ON HEALTH
Mervyn M. Dymally, Chair
SB 1096 (Calderon) - As Amended: May 23, 2008
SENATE VOTE : 21-16
SUBJECT : Medical information.
SUMMARY : Amends the Confidentiality of Medical Information Act
(CMIA) to authorize a pharmacy to mail written communications to
a patient without the patient's authorization, if specified
conditions are met. Specifically, this bill :
1)Creates an exception to the prohibition in the CMIA that
prohibits the sharing, selling, or use of a person's medical
information for marketing without the express authorization of
the person by defining a written communication mailed to a
patient by a pharmacy as necessary to provide health care
services to the patient, if all of the following conditions
are met:
a) The communication is written in the same language as the
prescription label produced by the pharmacy when the
medication is prescribed;
b) The written communications instructs the patient to
contact the prescribing or dispensing health care
professional if:
i) The patient has questions about the medication;
ii) The patient is having difficulty adhering to the
medication due to adverse effects, dosing requirements or
other causes.
c) The written communication pertains only to the
prescribed course of medical treatment, and does not
describe or mention any other pharmaceutical products.
Limits the written communication to the following diseases:
i) Diabetes;
ii) Osteoporosis;
iii) Asthma;
iv) Chronic Obstructive Pulmonary Disease;
SB 1096
Page 2
v) Cancer;
vi) Gastric Disorder;
vii) Hypertension;
viii) Cardiovascular Disease;
ix) Thyroid Disorder;
x) Organ Transplantation;
xi) Chronic Eye Disorder;
xii) Rheumatoid Arthritis and Osteoarthritis;
xiii) Renal Disorders;
xiv) Parkinson's Disease
xv) Seizures;
xvi) Multiple Sclerosis;
xvii) Depression;
xviii) Schizophrenia;
xix) Bipolar Disorder;
xx) Anxiety Disorders; and,
xxi) Attention Deficit Disorder.
d) Prohibits further written communication if there are no
refills remaining on the prescribed course of therapy and
there are no doses remaining on the final prescribed
refill, or the pharmacy has been notified by a health care
provider that a prescribed course of therapy has been
discontinued or substituted with a different drug;
e) Requires all product information in the written
communication to be consistent with current federal Food
and Drug Administration (FDA) approved product package
insert, and provide fair and balanced information regarding
the product's benefits and risks in accordance with the FDA
requirements and policies;
f) Requires a copy of each communication to be submitted to
the FDA Center for Drug Evaluation and Research, Division
of Drug Marketing, Advertising and Communications, prior to
program implementation;
g) Requires evidence-based or consensus-based practice
guidelines to be the basis of any information provided to
patients in order to improve overall patient health,
prevent clinical exacerbations or complications, or promote
patient self-management strategies;
h) Requires all personally identifiable medical information
collected, used or disclosed to be kept confidential and
SB 1096
Page 3
used solely to deliver the written communication to the
patient. Access to such information is limited to
unspecified authorized persons and any entity that receives
the information must comply with existing requirements
related to confidentiality and security, as specified;
i) Requires, if the communication is paid for by a
manufacturer, distributor, or provider of a health care
product or service, the communication to disclose whether
the pharmacy received direct or indirect remuneration from
a third party for making the communication and the
disclosure is in a clear and conspicuous location, in a
typeface no smaller than 14-point type; and,
j) Requires a pharmacy to offer the patient, at the time
the patient picks up his or her initial prescription an
opportunity to opt out, as specified, including at the time
a patient picks up the prescription and that the written
communication contains instructions for how the patient may
opt out of future communications.
EXISTING LAW :
1)Prohibits, under CMIA, a provider of health care, health care
service plan, or health care contractor from disclosing a
person's medical information without first obtaining that
person's authorization, except as specified. Specifically
prohibits the sharing, selling, or use of a person's medical
information for marketing without express authorization of the
person.
2)Defines "marketing," under the CMIA as a communication about a
product or service that encourages the recipient to purchase
or use the product or service. States that marketing does not
include any of the following:
a) Oral or written communications for which the
communicator does not receive direct or indirect
remuneration;
b) Certain specified communications to health plan
enrollees; or,
c) Remunerated communications that are tailored to the
individual circumstances of a person, as part of a disease
management program for chronic and seriously debilitating
or life-threatening conditions, to educate that person
SB 1096
Page 4
about both treatment options and adherence to a prescribed
course of medical treatment, if the person communicated to
is notified that the communicator has been remunerated and
by whom, and the person is given the opportunity to opt out
of future communications.
3)Prohibits, under the federal Health Insurance Portability and
Accountability Act (HIPAA), in general, covered entities from
using or disclosing personal health information (PHI) except
pursuant to a written authorization signed by the patient or
for treatment, payment or health care operations.
4)Prohibits, under HIPAA, health care entities from disclosing
PHI for "marketing" without prior authorization from the
patient, and further requires that the authorization specify
when the marketing involves direct or indirect remuneration to
the entity from a third party. Exempts from this prohibition,
marketing in the form of a "face-to-face communication" from
the entity to the individual.
5)Defines "marketing" under HIPPA to include communications
about a product or service that encourages the recipient to
purchase or use the product or service, except where the
communications: describe a health-related product or service
that is provided by, or included in a plan of benefits of, the
provider; are made for the treatment of the individual; or,
are made for case management or care coordination, or to
recommend alternative treatments to the individual.
6)Under federal law, if a HIPAA privacy provision conflicts with
a provision of state law, the provision that is most
protective of patient privacy prevails.
7)Under federal Public Law 104-180, enacted in 1995, establishes
a national goal of providing useful written prescription drug
information to consumers with the specific goal of providing
that information to 75% of individuals receiving new
prescriptions by the year 2000 and to 95% by the year 2006.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
intended to clarify that written communication about the
SB 1096
Page 5
specific prescription drug a patient is receiving, as compared
to information on other potential prescription drugs, products
or information is not marketing for purposes of the patient
privacy protections under the CMIA. The author contends that
it is well documented that adherence to chronic therapies is
very poor and offers extensive evidence related to the levels
of non-adherence to treatment regimens for chronic conditions.
According to the author, non-adherence to prescription drug
therapy costs the United States (U.S.) health care system over
$177 billion each year. The author points out that many
pharmacies currently run programs to provide patients
information about their prescriptions, including information
on how to take the medication, the potential side effects, the
importance of staying on therapy, as well as refill reminders
by mail. The author contends that these types of programs are
considered "treatment" under federal HIPAA but some pharmacies
and pharmaceutical companies are reluctant to support these
programs because California's medical privacy law does not
define these programs as treatment.
2)BACKGROUND . The appropriate use of personal health
information is an increasingly important issue as medical
records evolve into electronic files, and large, sophisticated
insurance, billing and care management databases are developed
by health plans and providers with multiple purposes.
Organizations that provide or pay for health care now
routinely collect information on patient diagnoses,
prescriptions, and health services utilization. Patient
databases can be the foundation of important care management
and case management programs, can allow health plans and
providers to effectively communicate with patients on their
care choices and options, and can facilitate improved quality
of care, through tracking, reporting and transparency of
health care services and outcomes. At the same time,
according to a February 2000 article in the Journal of the
American Medical Association ( JAMA ), "Uses and Abuses of
Prescription Drug Information in Pharmacy Benefits Management
Programs," breaches of confidentiality in electronic files may
be more serious than with paper records because databases
allow access to large amounts of information on many
individuals. Though recent changes to U.S. Department of
Health and Human Services HIPAA regulations may allow
pharmaceutical companies to access patients' personal medical
records, California law is far stricter in preserving the
confidentiality of patient medical information. Federal
SB 1096
Page 6
regulations establish only minimum standards that are exceeded
by laws in many states, including California.
The JAMA article also states that professional ethics require
physicians to maintain patient confidentiality, which enables
people to seek medical care and to disclose information to
their providers. Confidentiality also prevents stigma and
discrimination in health insurance or employment.
Furthermore, confidentiality ensures respect for patients as
persons because patients are offended by breaches of
confidentiality, even breaches that health care professionals
may consider commonplace (e.g., using patients' names in
discussion). For these reasons, state and federal laws place
role-specific obligations on health care providers to protect
confidentiality. Although confidentiality is important, there
are exceptions, including patients authorizing disclosure of
information. Even without patient permission, health care
providers may be required by law to report certain infectious
diseases to public health officials, gunshot wounds to police,
and serious threats of violence by psychiatric patients to
intended victims. These exceptions to confidentiality are
ethically justified because they prevent physical harm to
third parties or protect the public health. Other exceptions
to confidentiality may be ethically justified because patients
benefit from the efficient flow of personal health
information. The JAMA article points out, however, that it
may be difficult to determine and demonstrate patient benefit
for individual programs and purposes.
3)CMIA . CMIA is the principle California statute governing the
confidentiality of medical information, and generally
speaking, prohibits a health care provider, health plan,
health insurer or pharmaceutical manufacturer from disclosing
patient medical information absent an authorization signed by
the patient or the patient's legal representative in
compliance with strict statutory standards. The CMIA defines
a pharmaceutical company as any company that manufactures,
sells, or distributes pharmaceuticals, medications, or
prescription drugs, or its agents or representatives, but does
not include provider or pharmacy benefit programs. Under
CMIA, pharmaceutical companies are prohibited from requiring
patient to authorize disclosure of medical information as a
condition of receiving medications, except as follows: a) as
a condition to enrollment in a patient assistance program or
prescription drug discount program; b) as a condition to
SB 1096
Page 7
enrollment in clinical trial; c) as a condition of prior
access to medications in limited supply; or, d) as a condition
to responding to patient communication.
4)PATIENT ADHERENCE . Adherence (compliance) is the degree to
which a patient follows a treatment regimen. For drugs,
adherence requires that the prescription be obtained promptly
and the drug be taken as prescribed in terms of dose, dosing
interval, and duration of treatment. The problem of poor
patient adherence has been extensively researched, but the
rates of nonadherence have not changed much in the past three
decades. Adherence is worst with chronic disorders requiring
complex, long-term treatment (e.g., juvenile diabetes,
asthma). Children are less likely than adults to follow a
treatment regimen. Parents may not clearly understand
prescription instructions and, studies show, within 15
minutes, forget about half of the information given by their
physician. Elderly persons follow treatment regimens as well
as other adults, but factors that decrease adherence (e.g.,
inadequate finances, use of multiple drugs or drugs that must
be taken several times a day) are more common among the
elderly.
An April 2008 research brief by the AARP Public Policy
Institute entitled, "How Prescription Drug Use Affects Health
Care Utilization and Spending by Older Americans: A Review of
the Literature," found that research does show that
appropriate prescription drug use can lead to improved health
outcomes for many chronic conditions and should be encouraged,
particularly among older adults with chronic conditions.
However, the AARP report also found that patient adherence to
prescription drug regimens can best be improved by reducing
prescription drug prices, adding coverage for the uninsured,
and reducing cost sharing for those with prescription drug
coverage. The research brief suggested that in order to
increase adherence to drug regimens it may be necessary to
target cost sharing for prescription drugs by type of
medication and patient condition to minimize unintended
consequences in other areas, such as non-drug spending and
health outcomes.
Other studies have noted that a multi-disciplinary approach,
involving health care practitioners at all levels may have the
greatest chance of improving patient adherence and could
include the following: a) simplifying the drug regimen
SB 1096
Page 8
characteristics, including providing patients with a variety
of adherence aids to help organize their medications (e.g.,
medication boxes) and remember dose times (alarms); b)
imparting knowledge through health care practitioners
communicating clearly the purpose for the drug, the dosage and
regimen; c) clinicians uncovering and addressing the belief
systems of patients which may serve as barriers to their
compliance; d) patient communication ranging from
physician-patient communication, sending mail or telephonic
reminders, to involving patients' families in the dialogue; e)
clinicians overcoming stereotypes and biases around which
patients may be most likely to fail in adhering to treatment
regimens; and, f) regular evaluation of patient adherence by
clinicians which can be done by self-reports, pill counting,
and in some cases measuring serum or urine drug levels.
5)NATIONAL COUNCIL ON PATIENT INFORMATION AND EDUCATION (NCPIE) .
The author provided a 2007 report by the National Council on
Patient Information and Education (NCPIE), "Enhancing
Prescription Medicine Adherence: A National Action Plan" which
sets forth ten national priorities for improving patient
adherence to drug regimens. The author points out that one of
the ten NCPIE recommendations is to seek regulatory changes
and remove state or federal road-blocks for adherence
assistance, including ensuring that state and federal laws
related to patient privacy and the use of prescription data do
not unduly limit the ability of pharmacies to communicate with
patients about the importance of adhering to their prescribed
course of therapy. According to the NCPIE Internet web site,
NCPIE is a coalition of over 125 diverse organizations whose
mission is to stimulate and improve communication of
information on appropriate medicine use to consumers and
health care professionals. NCPIE members include consumer,
business, and health care professional organizations,
government agencies and non-government standard setting
organizations. NCPIE's average annual revenues of
$350,000-$400,000 per year come primarily from member dues,
with business organizations paying the highest dues level of
$7,500 per year, and consumer organizations paying annual dues
of $150.
6)PENDING LAWSUIT . There is a class action lawsuit pending in
San Diego Superior Court, Weisz v. Albertsons, Inc;
Sav-On-Drug Stores, Inc.; Osco Drug, Inc., Jewel Osco, Inc.;
Elensys, Inc.; Adheris, Inc ., Case No. GIC830069, San Diego
SB 1096
Page 9
County Superior Court. The complaint alleges that Albertsons'
pharmacy customers received direct mail and phone
solicitations derived from confidential customer medical
information provided to the pharmacy solely to fill
prescriptions. A plaintiff, Privacy Rights Clearinghouse
(Clearinghouse), alleges that Albertsons receives between
$3.00 and $4.50 from pharmaceutical companies per inquiry
letter and $12 to $15 per phone inquiry. Plaintiffs further
allege that Albertsons' pharmacies extracted customer
confidential medical information from prescriptions and then
placed it in a database that can be retrieved by specific
medical characteristics. According to the complaint,
Albertsons sold this information to pharmaceutical companies
in order to pursue carefully crafted marketing campaigns
without pharmacy customers' written authorization. The
lawsuit contends that pharmaceutical companies wrote or
approved the content of the solicitations to the pharmacies'
customers, which were processed and mailed by Albertsons
marketing personnel on its letterhead.
7)POTENTIAL FOR ABUSE . According to the 2000 JAMA article, a
pharmacy program that made headlines in 1998 dramatized how
personal health information can be both used and abused in the
era of managed care and computers. Two Washington, D.C.,
pharmacy chains, CVS and Giant Foods, sent patient
prescription records to a database marketing firm, Elensys
(former corporate name of Adheris, Inc. (Adheris) the sponsor
of this bill). Elensys mailed patients reminders to refill
prescriptions or information about new drugs as proposed to be
authorized in this bill. One mailing informed patients who
had purchased products for nicotine replacement therapy about
bupropion, a new pill for smoking cessation. Drug
manufacturers paid the pharmacy chains and Elensys for these
mailings. Until they received the letters, patients did not
know that their medical information was being used in this
way. Elensys said that drug companies had no direct access to
pharmacy records and that patients could opt out of the
program by returning a form. Critics objected that the
program crossed the line between medicine and marketing.
According to the JAMA article, critics of the Elensys project
objected that its goal was self-interest rather than patient
benefit, that patients did not authorize it, that third
parties had access to confidential health information, and
that safeguards for confidentiality were lacking. In
addition, JAMA reported that many patients in the Elensys
SB 1096
Page 10
program felt wronged because they had not authorized the sale
of their personal health information. The pharmacy chains
canceled the program after news stories elicited public
outrage.
8)LEGISLATIVE HISTORY . In 2003, the Legislature enacted AB 715
(Chan), Chapter 562, Statutes of 2003, to help ensure that
California law protects patients against the unauthorized use
of their medical information for marketing purposes. AB 715
requires health care providers to obtain authorization from a
patient before using the patient's medical information for
"marketing," and specifically prohibited health care providers
from accepting direct or indirect remuneration to communicate
with a patient regarding a product or service if the
communication encouraged the patient to purchase or use that
product or service, except in specified circumstances.
The next year, Catalina Health Resource, a company that partners
with pharmacies to produce communications that are the subject
of this bill, joined pharmacists and retailer groups in
sponsoring AB 746 (Matthews) of 2004. AB 746 would have
exempted from the AB 715 marketing prohibitions any written
communication from a pharmacist to a patient during the
"face-to-face" dispensing of a prescription drug, regardless
of marketing content, if the pharmacist is available to answer
questions about the communication, the communication assists
the pharmacy in meeting the goals of federal requirements to
distribute useful information regarding a dispensed
prescription drug, and the communication is, in its
"majority," made up of health information relating to the
disease or health condition for which the dispensed drug was
prescribed. AB 746 faced opposition from consumer groups
including Consumers Union and the California Public Interest
Research Group (CALPIRG), and died in the Senate.
Consumers Union, CALPIRG, and other consumer groups then
sponsored SB 401 (Ortiz) in 2005, attempting to explicitly
designate written communications given by a pharmacist to a
patient as "marketing" when they are sponsored by a third
party and include the trade name or commercial slogan for a
drug or therapy other than the drug or therapy being
dispensed. SB 401 made exceptions for names or slogans
provided for specified medical purposes. SB 401 passed the
Senate, but died in the Assembly.
SB 1096
Page 11
Late in the 2006 session, Catalina sponsored AB 2364 (De La
Torre), which would have amended the CMIA to allow "marketing"
of "sponsored" or "paid advertisements" by third parties to
pharmacy patients when they pick up their prescriptions. AB
2364 died in the Senate. In 2007, AB 1587 (DeLaTorre), also
sponsored by Catalina, and virtually identical to AB 2364,
failed passage in the Senate Judiciary Committee. Also in
2007, Adheris, sponsor of this bill, sponsored SB 843
(Calderon), virtually identical to this bill, but SB 843 was
never heard in committee.
9)RELATED LEGISLATION .
a) SB 843 (Calderon), pending in the Senate, would allow a
pharmacy to make specified communications to a patient,
without the patient's authorization, so long as the patient
may opt out of receiving those communications, as
specified. SB 843 would also require disclosure if the
communications are paid for by a manufacturer, distributor,
or provider of a health care product or service.
b) AB 1587 (De La Torre) exempts from the definition of
marketing, for purposes of CMIA, certain written
communications given by a pharmacist to a patient when a
prescription is dispensed. AB 1587 is set for hearing on
June 24, 2008 in the Senate Committee on Judiciary.
10)SUPPORT . Adheris supports this bill arguing that it would
provide California residents with a clear health care benefit
through the provision of valuable information to prescription
drug consumers. Adheris offers data showing that adherence to
chronic therapies is estimated to be at 50% and that
non-adherence can result in suboptimal clinical outcomes for
patients. Adheris contends that an important approach to
addressing the problem of non-adherence is the provision of
information to patients about the prescriptions doctors have
written for them. Adheris describes itself as a provider of
adherence programs and, under federal HIPAA, for purposes of
sharing patient medical information, a business associate of
its retail pharmacy clients. Adheris claims that
communications mailed as part of these programs are unbiased
and always consistent with current FDA-approved product
package insert, and provide fair and balanced information on
the product risk and benefits. Adheris maintains that this
bill is necessary because California law does not clearly
SB 1096
Page 12
define these types of programs as treatments, making
California pharmacies and pharmaceutical companies reluctant
to participate. The National Association of Chain Drug Stores
states that this bill will ensure that patients receive
written information that helps them better understand their
health conditions and preventive care and obtain optimal
results from their treatments. The American Russian Medical
Association supports this bill, stating it would like to see
patients continually informed with communications that
increase adherence and compliance with their prescribed
treatments. The National Association of Cancer Patients
believes this bill would improve the treatment of cancer
patients and others with chronic diseases by providing them
with additional information about the medicines they take to
treat the disease.
11)OPPOSITION . Consumer advocacy and provider organizations
oppose this bill stating that this bill raises significant
patient privacy concerns. The California Medical Association
(CMA) is concerned that this bill would interfere with the
doctor-patient relationship. CMA contends that the
communications authorized in this bill, presumably using
third-party materials from drug makers, would neither require
the patient's authorization nor a physician's recommendation
for the information to arrive in the mailbox. CMA argues that
this bill allows pharmaceutical marketing entities to practice
medicine through the mail, outside of any physician/patient
interaction. CMA further argues that pharmacies do not have
information on diagnoses so the language in this bill
permitting the mailings based on diagnoses is unworkable and
troubling.
The Clearinghouse states that pharmacies providing information
to patients is allowable under the CMIA but this bill is only
needed because of third party involvement in and payment for
the mailings authorized. The Clearinghouse states that this
bill would allow a third party, drug manufacturers and drug
marketing entities, to send reminder mailings that may be in
direct contradiction of the physician's recommended course of
treatment. The Clearinghouse maintains that it is a simple
but critical principle of privacy protection that if a
person's private information is to be used, transferred or
disclosed, they should be asked about it first and must agree
SB 1096
Page 13
to the disclosure, otherwise known as "opting in."
Health Access opposes this bill because it increases direct to
consumer drug advertising; allows pharmacists to violate
patient privacy by selling patient information; allows drug
companies to decide what types of drug effectiveness
information is provided to consumers, where they might
overstate benefits and understate negative effects; and,
interferes with the doctor-patient relationship.
The American Civil Liberties Union (ACLU) references the right
of privacy in the California Constitution and quotes from the
initiative which added that provision that it was intended to
"prevent government and business interests from stockpiling
unnecessary information about us and from misusing information
gathered for one purpose in order to serve another purpose or
to embarrass us." ACLU writes in opposition that most people
consider their medical and financial information among the
most private information about them. ACLU concludes that
disclosure of medical information generally should only take
place with the individual's affirmative consent, unless there
is some compelling state interest and the disclosure is
narrowly tailored to meet that interest.
The State Board of Pharmacy opposes this bill expressing serious
concerns that if enacted, this bill would provide consumers
with potentially unnecessary marketing information, disguised
as medical information, but which is sponsored by drug
manufacturers. The Department of Health Care Services (DHCS)
opposes this bill because there is no enforcement mechanism at
FDA to review and approve the materials that will be submitted
to FDA as required by this bill. Finally, DHCS is concerned
that this bill could increase costs to the Medi-Cal program by
encouraging inappropriate use of more expensive drugs marketed
via the mailings.
12)POLICY QUESTIONS .
a) Approach . In order to fall within the limits of the
CMIA, this bill would define pharmacy mailings as treatment
"necessary to provide health care services." In general,
a patient's health care provider is the one who determines
a patient's course of treatment, including any medications
needed. Should information provided by pharmacists and
potentially developed and paid for by drug manufacturers,
SB 1096
Page 14
however informative or useful, be considered "treatment"
under the law?
b) Privacy concerns . This bill would authorize disclosure
of communications from pharmacies, without the patient's
consent, if, among other things, the communication
encourages the patient to adhere to a prescribed course of
treatment. Presumably the mailings will be targeted and
rely on specific patient information about current and past
medications, gender, age, etc., and given the specified
conditions in this bill, assumptions about the underlying
health conditions for which the medications were
prescribed, in order to provide relevant information.
Access to the patient's information would be limited to
"authorized persons" but exactly who would be authorized is
not defined. Given that a patient's medical information
is one of the most private and sensitive areas of
information about a person, should this bill require
affirmative patient authorization, an opt-in instead of
only an opt-out, before any such materials can be sent to
the patient?
SB 1096
Page 15
c) Nature of the information .
i) This bill requires the written communications that
will be sent to patients to be consistent with
FDA-approved product package inserts. DHCS indicates
that there is no mechanism at FDA for review and approval
of the types of informational materials as are
contemplated in this bill. In addition, pharmacies are
not subject to FDA regulation and would be the entities
sending the materials. How would enforcement of these
provisions be ensured and who would be responsible for
enforcement?
ii) This bill requires that communications which will be
sent to patients be based on evidence or consensus but
provides no further definition. What standards would
apply to the requirement for evidence-based or
consensus-based information to be used in the materials?
iii) This bill limits communications to those encouraging
the patient to adhere to the "prescribed course of
treatment." However, the pharmacy will have the
information about prescriptions filled, but may not know
the health care provider's recommended duration or full
treatment regimen. A particular pharmacy may not have
information about all of the patient's prescriptions and
information could be provided for drugs that might
interact with other medicines the patient is taking.
What assurances are there that the material and
information provided to patients will be consistent with
the directions and recommendations of their personal
health care provider? How will the information be
developed in a way to avoid encouraging patients to seek
medications that might conflicts with prescriptions not
filled at the pharmacy sending the materials?
d) Costs . To the extent that these programs encourage
adherence to a brand name instead of a generic, costs could
increase for both patients and any third party payers.
Might the provisions of this bill result in increased
overall health care costs for state programs, such as
Medi-Cal, and for private insurance?
13)DOUBLE REFERRAL . This bill has been double referred. Should
this bill pass out of this committee, it will be referred to
the Assembly Committee on Judiciary.
SB 1096
Page 16
REGISTERED SUPPORT / OPPOSITION :
Support
Adheris, Inc. (sponsor)
American Russian Medical Association
Asthma & Allergy Foundation of America - California Chapter
California Council of Community Mental Health Agencies
California Retailers Association
California Seniors Advocate League
Community Life Improvement Program
Global Russian American Health Alliance
Los Angeles Society of Allergy, Asthma & Clinical Immunology,
Inc.
Mental Health Association in California
National Association of Cancer Patients
National Association of Chain Drug Stores
National Consumers League
Rite Aid
Opposition
AARP
American Civil Liberties Union
California Academy of Family Physicians
California Alliance for Retired Americans
California Department of Health Care Services
California Medical Association
California Nurses Association
California Pharmacists Association
California State Board of Pharmacy
Consumer Federation of California
Consumer Watchdog
Consumers Union
Department of Health Care Services
Health Access
Planned Parenthood Affiliates of California
Planned Parenthood Golden Gate
Planned Parenthood Mar Monte
Privacy Rights Clearinghouse
Analysis Prepared by : Deborah Kelch / HEALTH / (916)
319-2097