BILL NUMBER: AB 1124 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 31, 2015
AMENDED IN SENATE AUGUST 17, 2015
AMENDED IN SENATE JULY 14, 2015
AMENDED IN SENATE JULY 8, 2015
AMENDED IN ASSEMBLY JUNE 1, 2015
AMENDED IN ASSEMBLY APRIL 14, 2015
INTRODUCED BY Assembly Member Perea
FEBRUARY 27, 2015
An act to amend Sections 4600.1, 4600.2, and 5307.27 of, and to
add Sections 5307.28 and 5307.29 to, the Labor Code, relating to
workers' compensation.
LEGISLATIVE COUNSEL'S DIGEST
AB 1124, as amended, Perea. Workers' compensation: prescription
medication formulary.
Existing law establishes a workers' compensation system,
administered by the Administrative Director of the Division of
Workers' Compensation, to compensate an employee for injuries
sustained in the course of employment. The administrative director is
authorized to adopt, amend, or repeal, after public hearings, any
rules and regulations that are reasonably necessary to enforce the
state workers' compensation provisions, except when that power is
specifically reserved to the Workers' Compensation Appeals Board.
Existing law requires the administrative director to adopt a medical
treatment utilization schedule that addresses the frequency,
duration, intensity, and appropriateness of all common treatments
performed in workers' compensation cases.
This bill would require the administrative director to establish
an outpatient prescription a drug
formulary, on or before July 1, 2017, as part of the medical
treatment utilization schedule, for medications prescribed in the
workers' compensation system. The bill would require the
administrative director to make certain considerations, as specified,
in establishing the formulary. The bill would require the
administrative director to meet and consult with stakeholders, as
specified, prior to the adoption of the formulary. The bill would
require the administrative director to publish at least 2 interim
reports on the Internet Web site of the Division of Workers'
Compensation describing the status of the establishment of the
formulary, beginning July 1, 2016, until the formulary is effective.
The bill would require the administrative director to update the
formulary at least on a quarterly basis to allow for the availability
of all appropriate medications, including medications newly approved
for use. The bill would exempt an order updating the formulary
from the Administrative Procedure Act and other provisions, as
specified. The bill would also make conforming changes to
related code sections.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. It is the intent of the Legislature to
establish an outpatient prescription drug formulary for medications
prescribed in the workers' compensation system, to be effective July
1, 2017. In establishing the formulary, that the
Administrative Director of the Division of Workers' Compensation
shall consider, create an evidence-based drug
formulary, with the maximum transparency possible, a
medical evidence-based formulary, and, for use in the
workers' compensation system. The formulary shall go into effect on
or before July 1, 2017, and shall include, in addition to the
provisions of this act, at least all of the following:
(a) Medical evidence-based Evidence-based
guidelines for access to appropriate medication
medications pursuant to pain management
prescription drug therapies.
(b) Medical evidence-based guidelines for access to off-label
prescription drugs when evidence-based and medically necessary.
(b) Guidance regarding the manner in
which a physician may present medical evidence to document an injured
worker's need for off-label use of prescription drugs.
(c) Guidance of regarding the manner in
which utilization review, pursuant to Section 4610 of
the Labor Code, as applicable to review applies to
formulary medications within the established formulary
and circumstances that may warrant the use of
medications outside the established formulary.
formulary, including, but not limited to, emergent and inpatient
care.
SEC. 2. Section 4600.1 of the Labor Code is amended to read:
4600.1. (a) Subject to subdivision (b), any person or entity that
dispenses medicines and medical supplies, as required by Section
4600, shall dispense the generic drug equivalent.
(b) A person or entity is not required to dispense a generic drug
equivalent under either of the following circumstances:
(1) If a generic drug equivalent is unavailable.
(2) If the prescribing physician specifically provides in writing
that a nongeneric drug must be dispensed.
(c) For purposes of this section, "dispense" has the same meaning
as the definition contained in Section 4024 of the Business and
Professions Code.
(d) This section does not preclude a prescribing physician, who is
also the dispensing physician, from dispensing a generic drug
equivalent.
(e) This section applies only to medicines prescribed or
dispensed prior to the effective date of the
outpatient prescription drug formulary adopted pursuant to
Section 5307.27.
SEC. 3. Section 4600.2 of the Labor Code is amended to read:
4600.2. (a) Notwithstanding Section 4600, if a self-insured
employer, group of self-insured employers, insurer of an employer, or
group of insurers contracts with a pharmacy, group of pharmacies, or
pharmacy benefit network to provide medicines and medical supplies
required by this article to be provided to injured employees, those
injured employees that are subject to the contract shall be provided
medicines and medical supplies in the manner prescribed in the
contract for as long as medicines or medical supplies are reasonably
required to cure or relieve the injured employee from the effects of
the injury. Medicines provided pursuant to the contract are
shall be subject to the outpatient
prescription drug formulary adopted by the
administrative director pursuant to Section 5307.27, and a
contract shall not limit the availability of medications otherwise
indicated pursuant to the formulary.
prescribed pursuant to the formulary based on whether the pharmacy
services are provided within or outside a medical provider network.
(b) This section does not affect the ability of employee-selected
physicians to continue to prescribe and have the employer provide
medicines subject to the drug formulary and medical supplies that the
physicians deem reasonably required to cure or relieve the injured
employee from the effects of the injury.
(b)
(c) Each contract described in subdivision (a) shall
comply with standards adopted by the administrative director. In
adopting those standards, the administrative director shall seek to
reduce pharmaceutical costs and may consult any relevant studies or
practices in other states. The standards shall provide for access to
a pharmacy within a reasonable geographic distance from an injured
employee's residence.
(c) An employer or insurer that has established a medical provider
network pursuant to Section 4616 is in compliance with this section
if pharmacy network services are included within its medical provider
network plan filed with the administrative director pursuant to
paragraph (1) of subdivision (b) of Section 4616.
SEC. 4. Section 5307.27 of the Labor Code is amended to read:
5307.27. (a) The administrative director, in consultation with
the Commission on Health and Safety and Workers' Compensation, shall
adopt, after public hearings, a medical treatment utilization
schedule, that shall incorporate the evidence-based, peer-reviewed,
nationally recognized standards of care recommended by the commission
pursuant to Section 77.5, and that shall address, at a minimum, the
frequency, duration, intensity, and appropriateness of all treatment
procedures and modalities commonly performed in workers' compensation
cases.
(b) On or before July 1, 2017, the medical treatment utilization
schedule adopted by the administrative director shall include
an outpatient prescription drug formulary. a
drug formulary using evidence-based medicine. This section does
not prohibit the authorization of medications that are not in the
formulary when the variance is demonstrated, in accordance
consistent with subdivision (a) of Section
4604.5, to cure or relieve the injured worker from the
effects of his or her injury. 4604.5.
(c) The outpatient prescription drug formulary
shall include a phased implementation for workers injured prior to
July 1, 2017, in order to ensure injured workers safely transition to
medications on the formulary. This section does not
prohibit medically necessary tapering or weaning of medications to
treat workers injured on or after July 1, 2017.
(d) On or before July 1, 2017, the medical treatment utilization
schedule shall include guidelines for the development of a
detoxification plan for an injured worker receiving potentially
addictive prescription drug treatment or drug treatment if a
detoxification plan is necessary for patient safety.
SEC. 5. Section 5307.28 is added to the Labor Code, to read:
5307.28. (a) Prior to the adoption of an outpatient
prescription a drug formulary as required by
Section 5307.27, the administrative director shall meet and consult
regarding the establishment of a formulary with stakeholders,
including, but not limited to, employers, insurers, private sector
employee representatives, public sector employee representatives,
treating physicians actively practicing medicine, pharmacists,
pharmacy benefit managers, attorneys who represent applicants, and
injured workers.
(b) The administrative director may meet and consult with
include an independent research organization and
an ad hoc group of physicians and pharmacists to meet, and
consult with, to address proposed updates after the formulary
is implemented.
(c) Beginning July 1, 2016, and concluding with the effective date
of the formulary, the administrative director shall publish at least
two interim reports on the Internet Web site of the Division of
Workers' Compensation describing the status of the establishment of
the formulary.
SEC. 6. Section 5307.29 is added to the Labor Code, to read:
5307.29. The administrative director shall update the outpatient
prescription drug formulary at least on a quarterly basis to allow
for the availability of all appropriate medications, including
medications newly approved for use. Formulary updates shall be
made through an order exempt from Sections 5307.3, 5307.4, and the
rulemaking provisions of the Administrative Procedure Act (Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title
2 of the Government Code), informing the public of changes and their
effective date. All orders issued pursuant to this section shall be
published on the Internet Web site of the Division of Workers'
Compensation.