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
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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,
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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,
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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
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Today Pharmacy
Walgreens
Several individuals
Opposition
None on file.
Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916)
319-3301