BILL NUMBER: AB 623	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member Wood

                        FEBRUARY 24, 2015

   An act to amend Section 1367.22 of the Health and Safety Code,
relating to prescription drugs.


	LEGISLATIVE COUNSEL'S DIGEST


   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:

  SECTION 1.  The Legislature finds and declares the following:
   (a) Prescription and over-the-counter (OTC) drugs are, after
marijuana and alcohol, the most commonly abused substances by
Americans over 14 years of age.
   (b) Over two million people in the United States suffer from
substance use disorders related to prescription opioid pain
relievers.
   (c) More people die from overdoses of prescription opioid pain
relievers than from all other drugs combined, including heroin and
cocaine.
   (d) Prescription opioid pain relievers can have effects similar to
heroin when taken in doses or in ways other than prescribed, and
research now suggests that abuse of these drugs may lead to heroin
abuse.
   (e) Prescription opioid pain relievers can be particularly
dangerous when snorted, injected, or combined with other drugs or
alcohol.
  SEC. 2.  It is the intent of the Legislature to enact legislation
to address the problem of prescription opioid pain reliever abuse.
  SEC. 3.  Section 1367.22 of the Health and Safety Code is amended
to read:
   1367.22.  (a)     A health care service
plan contract, issued, amended, or renewed on or after July 1, 1999,
that covers prescription drug benefits shall not limit or exclude
coverage for a drug for an enrollee if the drug previously had been
approved for coverage by the plan for a medical condition of the
enrollee and the plan's prescribing provider continues to prescribe
the drug for the medical condition, provided that the drug is
appropriately prescribed and is considered safe and effective for
treating the enrollee's medical condition.  Nothing in this
  This  section shall  not  preclude the
prescribing provider from prescribing another drug covered by the
plan that is medically appropriate for the enrollee, nor shall
anything in this section be construed to prohibit generic drug
substitutions as authorized by Section 4073 of the Business and
Professions Code. For purposes of this section, a prescribing
provider shall include a provider authorized to write a prescription,
pursuant to subdivision (a) of Section 4059 of the Business and
Professions Code, to treat a medical condition of an enrollee.
   (b)     This section does not apply to
coverage for any drug that is prescribed for a use that is different
from the use for which that drug has been approved for marketing by
the federal Food and Drug Administration. Coverage for different-use
drugs is subject to Section 1367.21.
   (c)     This section shall not be
construed to restrict or impair the application of any other
provision of this chapter, including, but not limited to, Section
1367, which includes among its requirements that plans furnish
services in a manner providing continuity of care and demonstrate
that medical decisions are rendered by qualified medical providers
unhindered by fiscal and administrative management.
   (d)     This section does not prohibit a
health care service plan from charging a subscriber or enrollee a
copayment or a deductible for prescription drug benefits or from
setting forth, by contract, limitations on maximum coverage of
prescription drug benefits, provided that the copayments,
deductibles, or limitations are reported to, and held unobjectionable
by, the director and set forth to the subscriber or enrollee
pursuant to the disclosure provisions of Section 1363.