BILL ANALYSIS Ó AB 219 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 219 (Perea) As Amended September 4, 2013 Majority vote ----------------------------------------------------------------- |ASSEMBLY: |64-9 |(April 22, |SENATE: |29-9 |(September 9, | | | |2013) | | |2013) | ----------------------------------------------------------------- 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 Page 2 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 AB 219 Page 3 FN: 0002620