BILL ANALYSIS Ó
AB 299
Page 1
Date of Hearing: May 24, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 299 (Holden) - As Amended: May 14, 2013
Policy Committee: Business,
Professions and Consumer Protection Vote: 8-3
Health 11-6
Urgency: No State Mandated Local Program:
Yes Reimbursable: No
SUMMARY
This bill prohibits a health plan or insurer that provides
prescription drug benefits from requiring an enrollee to utilize
in-network mail order pharmacy services for covered prescription
drugs available at an in-network retail pharmacy. Prohibits the
plan or insurer from requiring authorization, from either the
plan or prescriber, for the enrollee's choice of obtaining a
drug through mail order or at a retail pharmacy. Excludes from
this provision drugs unavailable in retail pharmacies due to a
manufacturer's instructions or restrictions.
FISCAL EFFECT
Significant costs to publicly purchased health coverage
programs, including an estimate of $1.5 million to the
California Public Employees Retirement System (CalPERS).
COMMENTS
1)Rationale . This bill is intended to ensure a patient is able to
choose between retail pharmacies and mail order when filling a
prescription covered under a health insurance plan. According
to the author, all patients are different and what works for
one patient may not work for another. Many patients prefer to
receive their prescription drugs from their local pharmacy and
others prefer mail order. This bill is sponsored by the
California Pharmacists Association and supported by retail
pharmacies and numerous consumer organizations.
2)Background . Health plans and insurers use mail order pharmacies
AB 299
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as a way to control costs. Enrollees are given incentives,
such as lower prices, for choosing mail order. For some
patients, the trade-off of cheaper medications and home
delivery trumps face-to-face contact with a local pharmacist.
Other patients prefer the ability to speak with a pharmacist
familiar with other drugs the patient is taking so as to guard
against dangerous drug interactions.
Anthem Blue Cross imposed a policy on enrollees in 2012 to
require some drugs for HIV/AIDS and cancer to be purchased
through a single mail order pharmacy. After numerous
complaints, Anthem rescinded the new requirement. Health
plans and mail order pharmacies oppose this bill.
3)Previous legislation . SB 1301 (Ed Hernandez), Chapter 455,
Statutes of 2012, authorizes a pharmacist to dispense a 90-day
supply of a dangerous drug other than a controlled substance
pursuant to a valid prescription, except for psychotropic
medication or drugs or controlled substances, as specified.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081