BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1301|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: SB 1301
Author: Hernandez (D), et al.
Amended: 5/1/12
Vote: 21
SENATE HEALTH COMMITTEE : 8-1, 4/11/12
AYES: Hernandez, Harman, Alquist, Blakeslee, De León,
DeSaulnier, Rubio, Wolk
NOES: Anderson
SENATE BUSINESS, PROF. & ECON. DEV. COMM. : 7-0, 4/23/12
AYES: Price, Emmerson, Corbett, Correa, Hernandez,
Strickland, Wyland
NO VOTE RECORDED: Negrete McLeod, Vargas
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Prescription drugs: 90-day supply
SOURCE : California Retailers Association
DIGEST : This bill authorizes a pharmacist to dispense
not more than a 90-day supply of medication pursuant to a
valid prescription that specifies the initial dispensing of
a lesser amount followed by periodic refills of that amount
if the patient has completed an initial 30-day supply of
the medication, as specified.
ANALYSIS : Existing law:
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1. Provides for the practice of pharmacy and the licensing
and regulation of pharmacies and pharmacists by the
Board of Pharmacy within the Department of Consumer
Affairs.
2. Specifies certain requirements regarding the dispensing
and furnishing of dangerous drugs and devices, and
prohibits a person from furnishing any dangerous drug or
device except upon the prescription of a physician,
dentist, podiatrist, optometrist, or veterinarian.
3. Prohibits a prescription for any dangerous drug or
dangerous device from being refilled except upon
authorization of the prescriber, as specified.
4. Permits a prescription for a dangerous drug or dangerous
device to be refilled without the prescriber's
authorization if the prescriber is unavailable to
authorize the refill and if, in the pharmacist's
professional judgment, failure to refill the
prescription might interrupt the patient's ongoing care
and have a significant adverse effect on the patient's
well-being. Permits the prescription to be filled only
after making every reasonable effort to contact the
prescriber. Requires the pharmacist to inform the
patient and the provider that the prescription was
refilled under this circumstance.
This bill:
1. Authorizes a pharmacist to dispense not more than a
90-day supply of medication pursuant to a valid
prescription that specifies the initial dispensing of a
lesser amount followed by periodic refills of that
amount if the patient has completed an initial 30-day
supply of the medication and all of the following
requirements are satisfied:
A. The total quantity of dosage units dispensed does
not exceed the total quantity of dosage units
authorized by the prescriber on the prescription,
including refills.
B. The prescriber has not specified on the
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prescription that dispensing the prescription in an
initial amount followed by periodic refills is
medically necessary.
C. The pharmacist is exercising his/her professional
judgment.
2. Prohibits a pharmacist from dispensing a dangerous drug
pursuant to these provisions if the prescriber
personally indicates "Dispense as written" or words of
similar meaning.
3. Requires a pharmacist dispensing pursuant to these
provisions to notify the prescriber of the change in the
quantity dispensed.
4. Specifies that the above provisions do not apply to
psychotropic medication or psychotropic drugs as defined
in Welfare and Institutions Code Section 369.5 (d).
5. Specifies that the above provisions shall not be
construed to require a health care service plan, health
insurer, workers' compensation insurance plan, pharmacy
benefits manager, or any other person or entity,
including, but not limited to, a state program or state
employer, to provide coverage for a dangerous drug in a
manner inconsistent with a beneficiary's plan benefit.
Background
Pharmacy benefits managers (PBMs) and mail-order
pharmacies . Increasing numbers of employers, labor unions,
and managed care companies (collectively, "plan sponsors")
that offer prescription drug insurance coverage often hire
PBMs to manage these benefits. According to a 2005 Federal
Trade Commission study of PBMs, they use mail-order
pharmacies to manage prescription drug costs. Many PBMs
also own their own mail-order pharmacies. Plan sponsors
often encourage patients with chronic conditions who
require repeated refills to seek the discounts that 90-day
prescriptions and high-volume mail-order pharmacies can
offer. As medication prices continue to rise faster than
inflation, one method to control pharmacy benefit costs is
for health plans and PBMs to offer 90-day supply coverage
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which reduces costs via a decrease in dispensing fees and
potentially increases adherence, according to an article in
the American Journal of Health-System Pharmacy titled
"Ninety-day versus thirty-day drug dispensing systems."
The authors concluded that dispensing less expensive drugs
for 90 days rather than 30 days to patients with chronic
diseases would result in significant cost savings without
compromising safety, despite the possibility of increased
waste when drugs are discontinued.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 5/8/12)
California Retailers Association (source)
Aging Services of California
BIOCOM
California Healthcare Institute
Los Angeles County Board of Supervisors
National Association of Chain Drug Stores
ARGUMENTS IN SUPPORT : According to the California
Retailers Association (CRA) and the National Association of
Chain Drug Stores (NACDS), a single chain drug store makes
approximately 4.5 million calls a month to get
authorization to dispense a prescription refill in excess
of a 30-day supply. CRA and NACDS state that because
physicians are typically busy and unable to take these
calls, consumers end up either having to wait for
authorization or they end up settling for the 30-day
supply, leaving before the physician calls back. CRA,
NACDS, and Aging Services of California (ASC) write that
not only are these calls burdensome to the physicians and
pharmacists, the patient is ultimately inconvenienced and
will need to return to the pharmacy two additional times
and pay two additional co-payments that he/she would have
saved under this proposal. ASC further states that by
allowing a 90-day supply, this bill will make it easier for
patients to adhere to their treatment, live healthier lives
and lower costs throughout the health care system. The
County of Los Angeles contends that this bill will increase
access to needed medications and improve the health of many
County residents with chronic health conditions that are
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easily controlled with prescribed medications. BIOCOM
writes that this bill will likely reduce missed dosages and
increase dosage compliance by patients by allowing them to
have to refill prescriptions less often, and could reduce
total prescription costs by reducing the number of pharmacy
visits.
CTW:kc 5/9/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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