BILL NUMBER: AB 1826	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 28, 2010
	AMENDED IN ASSEMBLY  APRIL 28, 2010
	AMENDED IN ASSEMBLY  MARCH 15, 2010

INTRODUCED BY   Assembly Members Huffman and Feuer
   (Coauthors: Assembly Members Beall, Blumenfield, Hill, and
Saldana)
   (Coauthors: Senators DeSaulnier, Pavley, Price,  Wiggins,
 and Yee)

                        FEBRUARY 11, 2010

   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 1826, as amended, Huffman. Health care coverage: prescriptions.

   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 the act 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 covering prescription drug benefits to provide
specified coverage to subscribers, enrollees, and insureds.
   This bill would require  a  health care service
plan  or   contracts and  health 
insurer   covering   insurance policies
that cover outpatient  prescription drug benefits to provide
coverage for a drug that has been prescribed for the treatment of
pain  without first requiring   and would
prohibit those contracts and policies from requiring  the
subscriber, enrollee, or insured to  first  use another drug
or product  as specified  .
   The bill would specify that these provisions do not apply to a
health care service plan or health insurance policy purchased by the
Board of Administration of the Public Employees' Retirement System.
   Because a willful violation of the bill's 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 1367.225 is added to the Health and Safety
Code, to read: 
   1367.225.  (a) Every health care service plan covering
prescription drug benefits shall provide coverage for a drug that has
been prescribed by a participating licensed health care professional
for the treatment of pain without first requiring the subscriber or
enrollee to use an alternative prescription drug or an
over-the-counter product. 
    1367.225.    (a) A health care service plan contract
that covers outpatient prescription drug benefits shall provide
coverage for a drug that has been prescribed by a participating
licensed health care professional for the treatment of pain and shall
not require the subscriber or enrollee to first use an alternative
prescription drug or an over-the-counter drug, but may require the
subscriber or enrollee to first use a generically equivalent drug.
 
   (b) For the purposes of this section, "generically equivalent drug"
means drug products with the same active chemical ingredients of the
same strength, quantity, and dosage form, and of the same generic
drug name, as determined by the United States Adopted Names (USAN)
and accepted by the federal Food and Drug Administration (FDA), as
those drug products having the same chemical ingredients. 

   (b) 
    (c)  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. 
   (c) 
    (d)  This section shall not apply to a health care
service plan purchased by the Board of Administration of the Public
Employees' Retirement System pursuant to the Public Employees'
Medical and Hospital Care Act (Article 1 (commencing with Section
22750) of Chapter 1 of Part 5 of Division 5 of Title 2 of the
Government Code). 
   (d) 
    (e)  Nothing in this section shall be construed to
require coverage of prescription drugs not in a plan's drug formulary
or to prohibit  generically equivalent drugs or  generic
drug substitutions as authorized by Section 4073 of the Business and
Professions Code.
  SEC. 2.  Section 10123.197 is added to the Insurance Code, to read:

   10123.197.  (a) Every health insurer covering prescription drug
benefits shall provide coverage for a drug that has been prescribed
by a licensed health care professional for the treatment of pain
without first requiring the insured to use an alternative
prescription drug or an over-the-counter product. 
    10123.197.   (a) A health insurance policy that
covers outpatient prescription drug benefits shall provide coverage
for a drug that has been prescribed by a participating licensed
health care professional for the treatment of pain and shall not
require the insured to first use an alternative prescription drug or
an over-the-counter drug, but may require the insured to first use a
generically equivalent drug.  
   (b) For the purposes of this section, "generically equivalent drug"
means drug products with the same active chemical ingredients of the
same strength, quantity, and dosage form, and of the same generic
drug name, as determined by the United States Adopted Names (USAN)
and accepted by the federal Food and Drug Administration (FDA), as
those drug products having the same chemical ingredients. 

   (b) 
    (c)  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. 
   (c) 
    (d)  This section shall not apply to a health insurance
policy purchased by the Board of Administration of the Public
Employees' Retirement System pursuant to the Public Employees'
Medical and Hospital Care Act (Article 1 (commencing with Section
22750) of Chapter 1 of Part 5 of Division 5 of Title 2 of the
Government Code). 
   (d) 
    (e)  Nothing in this section shall be construed to
require coverage of prescription drugs not in an insurer's drug
formulary or to prohibit  generically equivalent drugs or 
generic drug substitutions as authorized by Section 4073 of the
Business and Professions Code.
  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.