as amended, Wood.
begin deletePrescription drugs. end delete
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.
begin delete 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.end delete
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.end delete
begin deleteno end delete.
State-mandated local program: begin deleteno end delete.
The people of the State of California do enact as follows:
The Legislature finds and declares the following:
2(a) Prescription and over-the-counter (OTC) drugs are, after
3marijuana and alcohol, the most commonly abused substances by
4Americans over 14 years of age.
5(b) Over two million people in the United States suffer from
6substance use disorders related to prescription opioid pain relievers.
P3 1(c) More people die from overdoses of prescription opioid pain
2relievers than from all other drugs combined, including heroin and
4(d) Prescription opioid pain relievers can have effects similar
5to heroin when taken in doses or in ways other than prescribed,
6and research now suggests that abuse of these drugs may lead to
8(e) Prescription opioid pain relievers can be particularly
9dangerous when snorted, injected, or combined with other drugs
It is the intent of the Legislature to enact legislation
7to address the problem of prescription opioid pain reliever abuse.
Section 1367.22 of the Health and Safety Code is
9amended to read:
(a) A health care service plan contract, issued,
11amended, or renewed on or after July 1, 1999, that covers
12prescription drug benefits shall not limit or exclude coverage for
13a drug for an enrollee if the drug previously had been approved
14for coverage by the plan for a medical condition of the enrollee
15and the plan’s prescribing provider continues to prescribe the drug
16for the medical condition, provided that the drug is appropriately
17prescribed and is considered safe and effective for treating the
18 enrollee’s medical condition. This section shall not preclude the
19prescribing provider from prescribing another drug covered by the
20plan that is medically appropriate for the enrollee, nor shall
21anything in this section be construed to prohibit generic drug
22substitutions as authorized by Section 4073 of the Business and
23Professions Code. For purposes of this section, a prescribing
24provider shall include a provider authorized to write a prescription,
25pursuant to subdivision (a) of Section 4059 of the Business and
26Professions Code, to treat a medical condition of an enrollee.
27(b) This section does not apply to coverage for any drug that is
28prescribed for a use that is different from the use for which that
29drug has been approved for marketing by the federal Food and
30Drug Administration. Coverage for different-use drugs is subject
31to Section 1367.21.
32(c) This section shall not be construed to restrict or impair the
33application of any other provision of this chapter, including, but
34not limited to, Section 1367, which includes among its
35requirements that plans furnish services in a manner providing
36continuity of care and demonstrate that medical decisions are
37rendered by qualified medical providers unhindered by fiscal and
39(d) This section does not prohibit a health care service plan from
40charging a subscriber or enrollee a copayment or a deductible for
P6 1prescription drug benefits or from setting forth, by contract,
2limitations on maximum coverage of prescription drug benefits,
3provided that the copayments, deductibles, or limitations are
4reported to, and held unobjectionable by, the director and set forth
5to the subscriber or enrollee pursuant to the disclosure provisions
6of Section 1363.