BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 146| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: SB 146 Author: Lara (D) Amended: 3/6/13 Vote: 21 SENATE LABOR & INDUSTRIAL RELATIONS COMMITTEE : 4-0, 3/13/13 AYES: Lieu, Wyland, Leno, Lara NO VOTE RECORDED: Padilla SUBJECT : Workers compensation: medical treatment: billing SOURCE : CompPharma DIGEST : This bill (1) provides that a copy of a prescription for pharmaceutical services is not necessary unless required under a written agreement between an employer, insurer, or third-party claims administrator and a pharmacy; (2) allows an employer insurer, or third-party claims administrator to request a copy of the prescription during a review of any records of prescription drugs dispensed by a pharmacy; and, (3) provides that any entity submitting a pharmacy bill for payment, on or after January 1, 2013, and denied payment for not including a copy of the prescription from the treating physician, shall have 90 days after January 1, 2014, to resubmit those bills for payment. ANALYSIS : Existing law: CONTINUED SB 146 Page 2 1. Establishes a workers' compensation system that provides benefits to an employee who suffers from an injury or illness that arises out of and in the course of employment, irrespective of fault. This system requires all employers to secure payment of benefits by either securing the consent of the Department of Industrial Relations to self-insure or by securing insurance against liability from an insurance company duly authorized by the state. 2. Provides that medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of his/her injury shall be provided by the employer. 3. Requires that any provider of medical services, including pharmacies, must submit its request for payment with an itemization of services provided and the charge for each service, a copy of all reports showing the services performed, the prescription or referral from the primary treating physician if the services were performed by a person other than the primary treating physician, and any evidence of authorization for the services that may have been received. This bill: 1. Provides that a copy of a prescription for pharmaceutical services is not necessary unless required under a written agreement between an employer, insurer, or third-party claims administrator and a pharmacy. 2. Allows an employer insurer, or third-party claims administrator to request a copy of the prescription during a review of any records of prescription drugs dispensed by a pharmacy. 3. Provides that any entity submitting a pharmacy bill for payment, on or after January 1, 2013, and denied payment for not including a copy of the prescription from the treating physician, shall have 90 days after January 1, 2014, to resubmit those bills for payment. CONTINUED SB 146 Page 3 Background SB 863 (DeLeon), Chapter 363, Statutes of 2012, created several new requirements for medical service providers when seeking reimbursement, including the submission of documents that appropriate detail the services provided and the cost of those services. This included the provision of a copy of a prescription for pharmaceutical services. After the passage of SB 863, several stakeholders reached out to the Legislature regarding the challenges of this requirement. Specifically, proponents note that there is no electronic method to transmit a paper prescription, and that the use of paper prescriptions is becoming increasingly rare. Additionally, some stakeholders have noted that other states have used electronic prescriptions, rather than paper prescriptions, as a method for combating opioid abuse. According to the Senate Labor and Industrial Relations Committee analysis, this bill addresses these concerns by: 1. Prohibiting the requirement of a prescription for pharmaceutical services by an employer, insurer, or third-party claims administrator, unless required by a written agreement between a specific pharmacy and an employer, insurer, or third-party claims administrator; 2. Allowing an employer, insurer, or third-party claims administrator to request a copy of the prescription during a review of records; and 3. Ensuring that any pharmacy that was denied payment due to the non-provision of a prescription can resubmit that bills within 90 days of January 1, 2013. FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local: No SUPPORT : (Verified 3/13/13) CompPharma (source) California Pharmacists Association California Retailers Association CVS/Caremark CONTINUED SB 146 Page 4 Express Scripts Holding Company Healthesystems Modern Medical, Inc. National Association of Chain Drug Stores Pharmacy Management Services Inc. Progressive Medical ARGUMENTS IN SUPPORT : Proponents argue that the requirement of a copy of a prescription with a request for payment is both unnecessary and an undue burden. Proponents note that the Division of Workers Compensation's electronic billing standard for pharmacy bills does not currently support the inclusion of attachments, making pharmacy billers unable to comply. Proponents also argue that a list of billed components provides the same information as prescription for pharmaceutical drugs, and that the requirement of a prescription may impact a pharmacy's ability to fill workers' compensation prescriptions, limiting access to medically necessary medication. Proponents believe that this bill will address this issue and ensure access to pharmaceutical products for injured workers. PQ:k 3/14/13 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED