AB 1831, as amended, Low. Health care coverage: prescription drugs: refills.
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 the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law imposes various requirements on health care service plan contracts and health insurance policies that cover prescription drug benefits.
This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after July 1, 2017, that provides coverage for prescription drugs benefits to allow for early refills of covered topical ophthalmic products according to specified standards. Because a willful violation of the bill’s requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 1367.249 is added to the Health and
2Safety Code, to read:
(a) A health care service plan contract issued,
4amended, or renewed on or after July 1, 2017, that provides
5coverage for prescription drug benefits shall allow for early refills
6of covered topical ophthalmic products according to the following
7standards:
8(1) For a 30-day supply, at least 23 days and less than 30 days
9from the later of either of the following:
10(A) The original date that the prescription was distributed to
11the enrollee.
12(B) The date of the most recent refill that was distributed to the
13enrollee.
14(2) For a 90-day supply, at least 68 days and less than 90 days
15from the later of either of the following:
16(A) The original date that the prescription was distributed to
17the enrollee.
18(B) The date of the most recent refill that was distributed to the
19enrollee.
20(3) The refills requested by the enrollee do not exceed the
21number of additional quantities prescribed by the enrollee’s
22participating health plan provider.
23(b) Nothing in this section shall prevent a plan contract from
24allowing for early refills atbegin delete 70end deletebegin insert
or below 75end insert percent of the predicted
25days of
use.
26(c) Nothing in this section shall be construed to establish a new
27mandated benefit or to prevent the application of deductible or
28copayment provisions in a plan contract.
Section 10123.209 is added to the Insurance Code, to
30read:
(a) A health insurance policy issued, amended, or
2renewed on or after July 1, 2017, that provides coverage for
3prescription drug benefits shall allow for early refills of covered
4topical ophthalmic products according to the following standards:
5(1) For a 30-day supply, at least 23 days and less than 30 days
6from the later of either of the following:
7(A) The original date that the prescription was distributed to
8the insured.
9(B) The date of the most recent refill that was distributed to the
10insured.
11(2) For a 90-day supply, at least 68 days and less than 90 days
12from the later of either of the following:
13(A) The original date that the prescription was distributed to
14the insured.
15(B) The date of the most recent refill that was distributed to the
16insured.
17(3) The refills requested by the insured do not exceed the number
18of additional quantities prescribed by the insured’s participating
19health plan provider.
20(b) Nothing in this section shall prevent a health insurance policy
21from allowing for early refills atbegin delete 70end deletebegin insert
or below 75end insert percent of the
22predicted days of use.
23(c) Nothing in this section shall be construed to establish a new
24mandated benefit or to prevent the application of deductible or
25copayment provisions in a health insurance policy.
No reimbursement is required by this act pursuant to
27Section 6 of Article XIII B of the California Constitution because
28the only costs that may be incurred by a local agency or school
29district will be incurred because this act creates a new crime or
30infraction, eliminates a crime or infraction, or changes the penalty
31for a crime or infraction, within the meaning of Section 17556 of
32the Government Code, or changes the definition of a crime within
33the meaning of Section 6 of Article XIII B of the California
34Constitution.
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