BILL ANALYSIS Ó
AB 1831
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ASSEMBLY THIRD READING
AB
1831 (Low)
As Introduced February 9, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |17-0 |Wood, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Campos, Chiu, Gomez, | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Olsen, Patterson, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |14-4 |Gonzalez, Bloom, |Bigelow, Gallagher, |
| | |Bonilla, Bonta, |Jones, Wagner |
| | |Calderon, Daly, | |
| | |Eggman, Eduardo | |
| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Quirk, Santiago, | |
| | |Weber, Wood | |
| | | | |
AB 1831
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SUMMARY: Requires health care service plan contracts and health
insurance policies issued, amended, or renewed on or after
January 1, 2017, that provide coverage for prescription drug
benefits to allow for early refills of covered topical
ophthalmic products (TOPs) at 70% of the predicted days of use.
States that nothing in this bill shall be construed to establish
a new mandated benefit or to prevent the application of
deductible or copayment provisions in a plan contract or
insurance policy.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)According to the California Health Benefits Review Program:
a) Costs of $360,000 to Medi-Cal (General Fund/federal) and
$4,000 to the California Public Employees' Retirement
System 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
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this requirement.
COMMENTS: According to the author, poor medication adherence is
a major barrier to achieving better patient outcomes. TOPS are
used to treat a variety of conditions including: uveitis,
conjunctivitis, dry eye, and glaucoma. Successful and effective
treatment for these eye-related conditions requires proper
administration of the medication. Eye drops can be difficult to
self-administer; a shaky hand can cause drops to hit the
patient's cheeks or make two eye drops come out at once. This
unavoidable waste is one reason that some patients run out of
their eye drops too soon. Interruptions in drug therapy for
eye-related conditions potentially have serious consequences,
including irreversible vision loss. Glaucoma patients are often
elderly and have difficulty dispensing the appropriate amount of
eye drops, thereby requiring early refills of their medication.
When patients run out of eye drops before the scheduled refill,
they may have to pay the full cost of the prescription. But
when faced with the option of paying full price for the
prescription or waiting until the scheduled refill date, many
choose to go without the medication for a week or more instead
of paying out of pocket. A study on glaucoma treatment
adherence cited an inadequate amount of medication available
between scheduled prescription refills as a central barrier to
patient compliance. By allowing early refill for users of TOPs,
patients are able to manage the disease and prevent
interruptions in drug therapy that can potentially have serious
consequences.
In 2010, the Centers for Medicare and Medicaid Services (CMS)
re-issued guidance on "Early Refill Edits on TOPs." The
reissuance was based on complaints CMS had received regarding
the application of early refill edits (i.e. refill-too-soon
edits) to TOPs. In the guidance, CMS recommended that Medicare
drug plans permit refills at 70% of the predicted days of use
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and permit physicians to authorize earlier refills for
particular beneficiaries who continue to have difficulty with
inadvertent wastage.
The California Academy of Eye Physicians and Surgeons, a
cosponsor of this bill, states in support that this bill is in
the patients' best interests, particularly for glaucoma and
antibiotic agents that can be viewed as sight-saving. The
California Optometric Association, also a cosponsor of this
bill, notes that it is a common occurrence for patients to have
drops hit their cheeks or to have two or more eye drops come out
of the bottle at once when only one is needed. This unavoidable
waste of drops is a major reason that some patients run out of
their drops too soon.
The California Association of Health Plans argues in opposition
that prescription eye drops are costly and there is no mechanism
to verify if a patient's eye drops were lost or spilled The
Association of California Health Insurance Companies and
America's Health Insurance Plans oppose all mandate bills
introduced this year because of possible state financial
exposure, the need for a robust health insurance marketplace
offering competition and choice, and the fact that mandates
stifle the use of innovative, evidence-based medicine.
Analysis Prepared by:
John Gilman / HEALTH / (916) 319-2097 FN:
0003215
AB 1831
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