BILL NUMBER: AB 1144 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 13, 2009
INTRODUCED BY Assembly Member Price
FEBRUARY 27, 2009
An act to add Section 1367.225 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 1144, as amended, Price. Health care coverage: prescriptions.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the regulation of health care service plans by the
Department of Managed Health Care and makes a willful violation of
the act's requirements a crime. Existing law provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires a health care service plan contract or a health
insurance policy that covers prescription drug benefits to provide
specified coverage to subscribers, enrollees, and insureds.
This bill would prohibit require a
health care service plan or a health insurer covering prescription
drug benefits from requiring a subscriber, enrollee, or an
insured who has been prescribed a product for the treatment of pain
by his or her health care provider to use a different specified
product prior to authorizing coverage of the product prescribed by
the health care provider to report to the Department
of Managed Health Care or to the Department of Insurance whenever it
requires an enrollee or insured to use certain pain medications prior
to providing access to a pain medication supported by a federal Food
and Drug Administration approved indication or to a pain medication
prescribed by the enrollee's or insured's health care provider, as
specified .
Because a willful violation of the bill's requirements with
respect to health care service plans would be a crime, it 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 1367.225 is added to the
Health and Safety Code , to read:
1367.225. (a) A health care service plan that covers prescription
drug benefits shall report to the department whenever it requires an
enrollee to do any of the following:
(1) Use a pain medication supported only by an off-label
indication prior to providing access to a drug supported by a federal
Food and Drug Administration approved indication.
(2) Use more than two formulary alternative medications prior to
providing access to a pain medication prescribed by the enrollee's
health care provider.
(3) Use a pain medication, other than the medication prescribed by
the enrollee's health care provider, for more than seven days prior
to providing access to the prescribed medication.
(b) The report shall include a statement describing why the plan
was authorized to impose the requirement on the enrollee.
SEC. 2. Section 10123.197 is added to the
Insurance Code , to read:
10123.197. (a) A health insurer that covers prescription drug
benefits shall report to the department whenever it requires an
insured to do any of the following:
(1) Use a pain medication supported only by an off-label
indication prior to providing access to a drug supported by a federal
Food and Drug Administration approved indication.
(2) Use more than two formulary alternative medications prior to
providing access to a pain medication prescribed by the insured's
health care provider.
(3) Use a pain medication, other than the medication prescribed by
the insured's health care provider, for more than seven days prior
to providing access to the prescribed pain medication.
(b) the report shall include a statement describing why the
insurer was authorized to impose the requirement on the insured.
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.
SECTION 1. Section 1367.225 is added to the
Health and Safety Code, to read:
1367.225. (a) No health care service plan that covers
prescription drug benefits shall require a subscriber or enrollee who
has been prescribed a product for the treatment of pain by his or
her health care provider use an alternative prescription or an
over-the-counter product prior to authorizing coverage of the product
prescribed by the health care provider.
(b) This section does not prohibit a health care service plan from
charging a subscriber or enrollee a copayment or a deductible for
prescription drug benefits or from setting forth, by contract,
limitations on maximum coverage of prescription drug benefits,
provided that the copayments, deductibles, or limitations are
reported to, and held unobjectionable by, the director and set forth
to the subscriber or enrollee pursuant to the disclosure provisions
of Section 1363.
SEC. 2. Section 10123.197 is added to the
Insurance Code, to read:
10123.197. (a) No health insurer that covers prescription drug
benefits shall require an insured who has been prescribed a product
for the treatment of pain by his or her health care provider to use
an alternative prescription or an over-the-counter product prior to
authorizing coverage of the product prescribed by the health care
provider.
(b) This section does not prohibit a health insurance policy from
charging an insured a copayment or a deductible for prescription drug
benefits or from setting forth, by contract, limitations on maximum
coverage of prescription drug benefits, provided that the copayments,
deductibles, or limitations are reported to, and held
unobjectionable by, the commissioner and set forth to the insured
pursuant to the disclosure provisions of Section 10603.
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.