BILL ANALYSIS Ó SB 1301 Page 1 Date of Hearing: June 19, 2012 ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER PROTECTION Mary Hayashi, Chair SB 1301 (Hernandez) - As Amended: May 1, 2012 SENATE VOTE : 34-0 SUBJECT : Prescription drugs: 90-day supply. SUMMARY : Allows pharmacists to dispense a 90-day supply of specified medications under a prescription for a lesser amount if the patient has completed an initial 30-day supply of the medication and other requirements are met. Specifically, this bill : 1)Authorizes a pharmacist to dispense not more than a 90-day supply of a dangerous drug other than a controlled substance 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 drug 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 prescription that dispensing the prescription in an initial amount followed by periodic refills is medically necessary; and, c) The pharmacist is exercising his or her professional judgment. 2)Requires a pharmacist dispensing pursuant to these provisions to notify the prescriber of the change in the quantity dispensed. 3)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. 4)Specifies that the above provisions do not apply to SB 1301 Page 2 psychotropic medication or psychotropic drugs as defined in the Welfare and Institutions Code, as specified. 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. EXISTING LAW 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. The prescription may be filled only after making every reasonable effort to contact the prescriber, and the pharmacist must inform the patient and the provider that the prescription was refilled under this circumstance. 5)Defines, pursuant to the Welfare and Institutions Code, psychotropic medication or psychotropic drugs to mean those medications administered for the purpose of affecting the central nervous system to treat psychiatric disorders or illnesses. These medications include, but are not limited to, anxiolytic agents, antidepressants, mood stabilizers, antipsychotic medications, anti-Parkinson agents, hypnotics, SB 1301 Page 3 medications for dementia, and psychostimulants. FISCAL EFFECT : Unknown COMMENTS : Purpose of this bill . According to the author, "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. "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 or she would have saved under this bill." Background . According to a 2005 Federal Trade Commission study, private-sector entities that offer prescription drug insurance coverage, such as employers, labor unions, and managed care companies, often hire pharmacy benefit managers (PBMs) to manage these insurance benefits. Many PBMs use mail-order pharmacies to manage prescription drug costs. Many plan sponsors have encouraged patients with chronic conditions who require repeated refills to seek the discounts that 90-day prescriptions and high-volume mail-order pharmacies can offer. One way of managing growing medication costs is by using larger prescription volumes. An article published in the July 2001 issue of the American Journal of Health-System Pharmacy reported a study involving the Veterans Affairs San Diego Healthcare System, which showed 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. According to the Sponsor, 20 states have varying statutes that in some way permit 90-day dispensing (Alaska, Arizona, Colorado, Florida, Hawaii, Idaho, Illinois, Kentucky, Main, Michigan, SB 1301 Page 4 Montana, Nebraska, New York, North Carolina, Rhode Island, South Carolina, South Dakota, Texas, Vermont, and Wyoming). For example, New York mandates that if a health plan or insurer offers a 90-day supply through a mail-order pharmacy, the enrollee can obtain the same supply at a retail pharmacy, provided the pharmacy accepts the same contractual terms and conditions as the mail-order pharmacy. Indiana has legislation that permits 90-days' worth of medication upon the request of the patient if the patient has completed an initial 30-day supply of the drug. Support . The California Retailers Association writes, "With our aging population, health care costs will rise dramatically and prescription drug expenditures will also increase as more people are diagnosed with conditions that require maintenance drugs. Consumers want and deserve the option of obtaining a 90-day prescription for their convenience and to allow them to better adhere to their medical regimen." REGISTERED SUPPORT / OPPOSITION : Support California Retailers Association (sponsor) Aging Services of California American Federation of State, County and Municipal Employees, AFL-CIO BayBio BIOCOM California Healthcare Institute California Medical Association California Optometric Association California Pharmacists Association California State Board of Pharmacy Congress of California Seniors Gray Panthers Greater Los Angeles African American Chamber of Commerce Greater Sacramento Urban League Latin Business Association Los Angeles County Board of Supervisors Mental Health America National Association of Chain Drug Stores Pacific Pride Foundation of Santa Barbara County Simi Valley/Moorpark Democratic Club St. Barnabas Senior Services SB 1301 Page 5 Today Pharmacy Walgreens Several individuals Opposition None on file. Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916) 319-3301