BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 219
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          CONCURRENCE IN SENATE AMENDMENTS
          AB 219 (Perea)
          As Amended September 4, 2013
          Majority vote
           
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          |ASSEMBLY:  |64-9 |(April 22,      |SENATE: |29-9 |(September 9,  |
          |           |     |2013)           |        |     |2013)          |
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           Original Committee Reference:    HEALTH  

           SUMMARY  :  Limits the total amount of copayments and coinsurance  
          an enrollee or insured is required to pay for orally  
          administered anticancer medications to $200 for an individual  
          prescription of up to a 30-day supply.

           The Senate amendments  delete the Assembly version of this bill,  
          and instead: 

          1)Require, notwithstanding any other law, an individual or group  
            health care service plan contract or health insurance policy  
            issued, amended, or renewed on or after January 1, 2015, that  
            provides coverage for prescribed, orally administered  
            anticancer medications used to kill or slow the growth of  
            cancerous cells to comply with all of the following:

             a)   Limit, notwithstanding any deductible, the total amount  
               of copayments and coinsurance an enrollee or insured is  
               required to pay to $200 for an individual prescription of  
               up to a 30-day supply of a prescribed orally administered  
               anticancer medication covered by the contract or policy;

             b)   Require for a health care service plan contract or  
               health insurance policy that meets the definition of a  
               "high deductible health plan" as specified, the limit in 1)  
               a) above to only apply once an enrollee's deductible has  
               been satisfied for the year;

             c)   Exempt from 1) a) above any coverage under the federal  
               Medicare program;

             d)   Permit on January 1, 2016, and on January 1 of each year  
               thereafter, health care service plans or health insurance  
               policies to adjust the $200 limit.  Limit the adjustment to  








                                                                  AB 219
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               the percentage increase in the Consumer Price Index for  
               that year; and,

             e)   Require a prescription for an orally administered  
               anticancer medication to be provided consistent with the  
               appropriate standard of care for that medication.

          2)Sunset this bill on January 1, 2019.

           AS PASSED BY THE ASSEMBLY,  this bill required health plan  
          contracts and health insurance policies that cover prescribed,  
          orally administered anticancer medications to limit an enrollee  
          or insured's total cost share to no more than $100 per filled  
          prescription.

           FISCAL EFFECT  :  According to the Senate Appropriations  
          Committee:

          1)One-time costs of $70,000 in 2013-14 and $90,000 in 2014-15  
            for review of health plan filings by the Department of Managed  
            Health Care.  Ongoing enforcement costs are expected to be  
            minor (Managed Care Fund).

          2)Minor ongoing enforcement cost by the California Department of  
            Insurance (Insurance Fund).

          3)No costs to state-run health care programs.  The Medi-Cal,  
            Healthy Families, and Access for Infants and Mothers programs  
            have limited or no cost sharing.  California Public Employees'  
            Retirement System health plans all have enrollee copayment  
            amounts for prescription drugs that are less than $100 per  
            prescription.

          4)No costs to provide subsidies for mandated benefits in the  
            California Health Benefit Exchange (General Fund).

           COMMENTS  :  The Senate amendments are not inconsistent with the  
          policy that was adopted in the Assembly version of this bill.   
          This bill still limits the cost sharing for orally administered  
          anticancer related medications.


           Analysis Prepared by  :    Teri Boughton / HEALTH / (916) 319-2097  










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          FN:  
          0002620