BILL ANALYSIS Ó
AB 1831
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Date of Hearing: May 4, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
1831 (Low) - As Introduced February 9, 2016
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|Policy |Health |Vote:|17 - 0 |
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY:
This bill requires health plans and insurers that provide
coverage for prescription drug benefits to allow for early
refills of covered topical ophthalmic products (eye drops and
ointments) at 70 percent of the predicted days of use.
FISCAL EFFECT:
1)According to the California Health Benefits Review Program
(CHBRP):
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a) $360,000 to Medi-Cal (GF/federal) and $4,000 to CalPERS
for increased premiums.
b) Increased employer-funded premium costs in the private
insurance market of approximately $260,000.
c) Increased premium expenditures by employees and
individuals purchasing insurance of $200,000, and increased
out-of-pocket expenses of $110,000.
2)Minor costs to the California Department of Insurance
(Insurance Fund) and the Department of Managed Health Care
(Managed Care Fund) to verify plans and insurers comply with
this requirement.
COMMENTS:
1)Purpose. This bill allows patients to refill their eye
medications earlier than scheduled in order to ensure they
have an adequate supply of prescribed drugs. This will
promote adherence to medication and prevent the potential
negative consequences of skipping doses. The author explains
individuals often have difficulty administering eye drops and
ointments in the proper quantities, leading to unavoidable
waste.
2)Background. Eye drops and ointments are used to treat a
variety of conditions, including conjunctivitis, dry eye, and
glaucoma. Interruptions in drug therapy for some eye-related
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conditions would potentially have serious consequences,
including irreversible vision loss. This bill aligns state
law with federal Medicare guidelines as it relates to refill
standards for eye drops and ointments, which was put into
place based on complaints the Center for Medicare and Medicaid
Services had received about the process for requesting early
refills.
3)CHBRP Analysis. According to CHBRP, most plans allow for
early refills, although at varying standards varying from
75-85%. CHBRP assumed that, on average, the possibility of
earlier refill coverage would result in one additional refill
per year among enrollees with a chronic condition and changed
benefit coverage. CHBRP does not project a measurable public
health or long-term impact, but notes that it stands to reason
the requirement may help those who have the greatest need for
the medication: those with severe chronic conditions resulting
in diminishing visual acuity.
4)Essential Health Benefits (EHBs). Federal law requires the
state to defray additional costs caused by any state mandates
that exceed a set of federally defined EHBs. CHBRP does not
believe this bill exceeds the federally defined EHBs; thus,
there is no expected state fiscal liability related to this
issue.
5)Support and Opposition. Health plans and insurers oppose this
bill, citing the cumulative impact of mandates as well as
difficulty operationalizing a "70% of fill" standard. This
bill is co-sponsored by the California Academy of Eye
Physicians and Surgeons and the California Optometric
Association, and supported by several other groups including
Health Access, AFSCME, and California Congress of Seniors.
6)Prior Legislation. AB 2418 (Bonilla) required health plans and
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insurers to allow for the synchronization of prescription
refills, and also contained requirements similar to this bill.
AB 2418 was vetoed by the Governor, who cited issues with the
refill synchronization provisions of the bill. The veto
message did not reference provisions related to eye drops and
ointments.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081