Amended in Assembly May 14, 2013

Amended in Assembly May 7, 2013

Amended in Assembly April 16, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 299

Introduced by Assembly Member Holden

(Coauthor: Assembly Member Bloom)

February 12, 2013

An act to add Section 1367.245 to the Health and Safety Code begin insert , end insert and to add Section 10123.193 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 299, as amended, Holden. Prescription drug benefits.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires every health care service plan that provides prescription drug benefits that maintains one or more drug formularies to provide to members of the public, upon request, a copy of the most current list of prescription drugs on the formulary.

This bill would begin delete require end delete begin insert prohibit end insert a health care service plan or health insurer that provides prescription drug benefits begin delete to authorize end delete begin insert from requiring end insert an enrollee or insured to begin delete receive those benefits, which may include a 90-day supply of covered drugs, end delete begin insert use mail order pharmacy services for covered end insert begin insert prescription drugs that are available end insert at begin delete any of its end delete begin insert an end insert in-network begin delete pharmacies that are retail pharmacies end delete begin insert retail pharmacy end insert , and would prohibit the begin delete plan or insurer end delete begin insert enrollee’s or insured’s exercise of choice with regard to obtaining those drugs from an in-network mail order pharmacy or an in-network retail pharmacy end insert from requiring any begin delete additional authorizations end delete begin insert authorization end insert by the plan or insurer or the prescriber begin delete that are not required for the enrollee or insured to receive those benefits at a mail order pharmacy end delete . The bill would specify that these requirements would not apply to drugs that are not available in retail pharmacies begin delete because of limited distribution by the manufacturer end delete begin insert due to a manufacturer’s instructions or restrictions end insert . Because a willful violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

SECTION 1.  

Section 1367.245 is added to the Health and
Safety Code, to read:

1367.245.  

begin delete (a) end delete begin delete   end delete A health care service plan that provides
prescription drug benefits shall begin delete authorize end delete begin insert not require end insert an enrollee
to begin delete receive those benefits, which may include a 90-day supply of
covered drugs, at any of its end delete begin insert utilize in-network mail order pharmacy
services for covered end insert begin insert prescription drugs that are available in an end insert
in-network begin delete pharmacies that are end delete retail begin delete pharmacies, and end delete begin insert pharmacy.
The enrollee’s exercise of choice with regard to obtaining covered end insert
begin insert prescription drugs from an in-network mail order pharmacy or
an in-network retail pharmacy end insert shall not require any begin delete additional
authorizations end delete begin insert authorization end insert by the plan or the prescriber begin delete that are
not required for the enrollee to receive those benefits at a mail
order pharmacy end delete . This subdivision shall not apply to drugs that are
not available in retail pharmacies begin delete because of limited distribution
by the manufacturer end delete begin insert due to a manufacturer’s instructions or
restrictions end insert .

begin delete

(b) A pharmacist who dispenses a 90-day supply of covered
drugs shall comply with Section 4064.5 of the Business and
Professions Code.

end delete

SEC. 2.  

Section 10123.193 is added to the Insurance Code, to
read:

10123.193.  

begin delete (a) end delete begin delete   end delete A health insurer that provides prescription drug
benefits shall begin delete authorize end delete begin insert not require end insert an insured to begin delete receive those
benefits, which may include a 90-day supply of covered drugs, at
any of its end delete begin insert utilize in-network mail order pharmacy services for
covered prescription drugs that are available in an end insert in-network
begin delete pharmacies that are end delete retail begin delete pharmacies, and end delete begin insert pharmacy. The insured’s
exercise of choice with regard to obtaining covered end insert begin insert prescription
drugs from an in-network mail order pharmacy or an in-network
retail pharmacy end insert shall not require any begin delete additional authorizations end delete
begin insert authorization end insert by the insurer or the prescriber begin delete that are not required
for the insured to receive those benefits at a mail order pharmacy end delete .
This subdivision shall not apply to drugs that are not available in
retail pharmacies begin delete because of limited distribution by the
manufacturer end delete begin insert end insert begin insert due to a manufacturer’s instructions or restrictions end insert .

begin delete

(b) A pharmacist who dispenses a 90-day supply of covered
drugs shall comply with Section 4064.5 of the Business and
Professions Code.

end delete

SEC. 3.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.