BILL ANALYSIS Ó
SB 1301
Page 1
Date of Hearing: June 26, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 1301 (Ed Hernandez) - As Amended: June 21, 2012
SENATE VOTE : 34-0
SUBJECT : Prescription drugs: 90-day supply.
SUMMARY : Permits pharmacists to dispense a 90-day supply of a
dangerous drug, other than a controlled substance or
psychotropic medication, pursuant to a prescription for a lesser
amount if the patient has completed an initial 30-day supply of
the medication and other specified conditions are met.
Specifically, this bill :
1)Allows a pharmacist to dispense a maximum of 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, provided that the patient has completed an initial
30-day supply of the drug and all of the following
requirements are met:
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 indicated on the prescription
that dispensing the prescription in an initial amount
followed by periodic refills is medically necessary; and,
c) The pharmacist is using his or her professional
judgment.
2)Requires a pharmacist dispensing an increased supply of a
dangerous drug pursuant to this bill to notify the prescriber
of the increase in the quantity dispensed.
3)Prohibits a pharmacist from dispensing a greater supply of a
dangerous drug pursuant to this bill if the prescriber
personally indicates, either orally, in writing, or
electronically, "Dispense as written" or words of similar
meaning, as specified.
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4)Exempts the provisions of this bill from applying to
psychotropic medication or psychotropic drugs as defined in
existing law.
5)Prohibits the provisions of this bill from being construed to
require a health 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)Defines "dangerous drug" to mean any drug unsafe for self-use
in humans or animals, and that can only be lawfully dispensed
with a prescription.
3)Specifies certain requirements governing the dispensing and
furnishing of dangerous drugs, and prohibits a person from
furnishing any dangerous drug except upon the prescription of
a physician, dentist, podiatrist, optometrist, or
veterinarian.
4)Prohibits a prescription for any dangerous drug from being
refilled except upon authorization of the prescriber, as
specified.
5)Allows a prescription for a dangerous drug 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.
6)Permits, pursuant to 5) above, the prescription to be refilled
only after every reasonable effort to contact the prescriber
is made, and requires the pharmacist to inform the patient and
the provider that the prescription has been refilled under
this circumstance.
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7)Defines psychotropic medication or psychotropic drugs as those
medications administered for the purpose of affecting the
central nervous system to treat psychiatric disorders or
illnesses, such as anxiolytic agents, antidepressants, mood
stabilizers, antipsychotic medications, anti-Parkinson agents,
hypnotics, medications for dementia, and psychostimulants.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, 10% of health
care spending in the U.S. results from non-adherence to
medication. The author states that a patient's failure to
adhere to their prescribed medication therapy can lead to
deterioration of the patient's health, that, in turn, can lead
to higher cost medications or more frequent medical
interventions. The author maintains that allowing patients to
receive up to 90 days-worth of a prescription refill will make
it easier for them to adhere to their treatment and live
healthier lives while reducing costs throughout the health
care system.
2)BACKGROUND . Studies indicate that one way employers, labor
unions, managed care organizations, and other entities can
control growing medication costs and improve medication
adherence is by using larger prescription volumes. A March
2010 article published in the Journal of Managed Care Pharmacy
found that adherence improves with a 90-day medication
supply. In the study, patients from a health plan in Illinois
were treated with long-term medications for one of three
conditions: high cholesterol, hypertension, or diabetes.
After 540 days of follow-up, patients with a 90-day supply of
medication were 7.1% to 9.9% more likely than those receiving
a 30-day supply to adhere to treatment. Additionally,
non-adherence was 40% less likely to occur in those patients
who received 90-day supplies of medication.
A study in the July 2001 issue of the American Journal of
Health-System Pharmacy involving the Veterans Affairs San
Diego Healthcare System found that dispensing less expensive
drugs for 90-days rather than 30-days to patients with chronic
diseases resulted in significant cost savings without
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compromising safety, despite the possibility of increased
waste when prescriptions were discontinued. The study noted
that a 90-day drug dispensing system cut the costs associated
with prescription filling and mailing by two-thirds compared
with a 30-day system.
3)OTHER STATES . According to the sponsor of this bill, the
California Retailers Association, 20 states have varying laws
that in some way permit 90-day dispensing. For example, New
York requires 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.
4)SUPPORT . The sponsor writes that the 90-day retail
prescription option in this bill offers more convenience and
access for the patient, reduces costs related to co-payments,
and promotes better health outcomes through regular medication
adherence. Walgreens notes in support that it makes 4.5
million calls to prescribers per month to obtain their
approval before dispensing a combined refill and this bill
reduces administrative burdens on physicians by negating the
need for those office contacts. The California Medical
Association states that this bill alleviates the need for the
pharmacist to contact the physician every time a standard
refill is required but preserves a physician's ability to
monitor a patient's progress and properly modify the patient's
drug regime if necessary. The Latin Business Association
writes in support that this bill is of interest to the Latino
community because it would assist those in low income areas
with filling their prescriptions in a timely manner when
getting to a pharmacy can be difficult. Lastly, the
California Pharmacists Association adds that this bill takes a
relatively small yet meaningful step to safely increase
efficiency in the health care delivery system.
5)DOUBLE-REFERRAL . This bill is double referred. It was heard
in the Assembly Business, Professions and Consumer Protection
Committee on June 19, 2012, and passed out on a 9-0 vote.
REGISTERED SUPPORT / OPPOSITION :
SB 1301
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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
Greater Los Angeles African American Chamber of Commerce
Latin Business Association
Los Angeles County Board of Supervisors
Mental Health Association in California
National Association of Chain Drug Stores
Walgreens
Individual pharmacists
Opposition
None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097