AB 623, as introduced, Wood. Prescription drugs.
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. These provisions require specified services and drugs to be covered by the various plans. The act prohibits specified health care service plan contracts that cover prescription drug benefits from limiting or excluding coverage for a drug for an enrollee under specified conditions, including if the drug previously had been approved for coverage by the plan for a medical condition of the enrollee.
This bill would make technical, nonsubstantive changes to that provision. This bill would also state the intent of the Legislature to enact legislation to address the problem of prescription opioid pain reliever abuse and would make related findings and declarations.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
The Legislature finds and declares the following:
P2 1(a) Prescription and over-the-counter (OTC) drugs are, after
2marijuana and alcohol, the most commonly abused substances by
3Americans over 14 years of age.
4(b) Over two million people in the United States suffer from
5substance use disorders related to prescription opioid pain relievers.
6(c) More people die from overdoses of prescription opioid pain
7relievers than from all other drugs combined, including heroin and
9(d) Prescription opioid pain relievers can have effects similar
10to heroin when taken in doses or in ways other than prescribed,
11and research now suggests that abuse of these drugs may lead to
13(e) Prescription opioid pain relievers can be particularly
14dangerous when snorted, injected, or combined with other drugs
It is the intent of the Legislature to enact legislation
17to address the problem of prescription opioid pain reliever abuse.
Section 1367.22 of the Health and Safety Code is
19amended to read:
begin delete end delete begin delete end delete A health care service plan contract, issued,
21amended, or renewed on or after July 1, 1999, that covers
22prescription drug benefits shall not limit or exclude coverage for
23a drug for an enrollee if the drug previously had been approved
24for coverage by the plan for a medical condition of the enrollee
25and the plan’s prescribing provider continues to prescribe the drug
26for the medical condition, provided that the drug is appropriately
27prescribed and is considered safe and effective for treating the
28 enrollee’s medical condition.
begin delete Nothing in thisend delete section shall
29 preclude the prescribing provider from prescribing another drug
30covered by the plan that is medically appropriate for the enrollee,
31nor shall anything in this section be construed to prohibit generic
32drug substitutions as authorized by Section 4073 of the Business
33and Professions Code. For purposes of this section, a prescribing
34provider shall include a provider authorized to write a prescription,
35pursuant to subdivision (a) of Section 4059 of the Business and
36Professions Code, to treat a medical condition of an enrollee.
begin delete end delete begin delete end delete This section does not apply to coverage for any drug that
38is prescribed for a use that is different from the use for which that
39drug has been approved for marketing by the federal Food and
P3 1Drug Administration. Coverage for different-use drugs is subject
2to Section 1367.21.
begin delete end delete begin delete end delete This section shall not be construed to restrict or impair
4the application of any other provision of this chapter, including,
5but not limited to, Section 1367, which includes among its
6requirements that plans furnish services in a manner providing
7continuity of care and demonstrate that medical decisions are
8rendered by qualified medical providers unhindered by fiscal and
begin delete end delete begin delete end delete This section does not prohibit a health care service plan
11from charging a subscriber or enrollee a copayment or a deductible
12for prescription drug benefits or from setting forth, by contract,
13limitations on maximum coverage of prescription drug benefits,
14provided that the copayments, deductibles, or limitations are
15reported to, and held unobjectionable by, the director and set forth
16to the subscriber or enrollee pursuant to the disclosure provisions
17of Section 1363.