BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1831 (Low) - Health care coverage: prescription drugs:
refills
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: June 9, 2016 |Policy Vote: HEALTH 9 - 0 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: Yes |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 1831 would require health insurers and health plans
to provide coverage for early refills of prescription topical
ophthalmic products (prescription eye drops).
Fiscal
Impact:
Minor costs to review health insurer filings and take
enforcement actions, as necessary, by the Department of
Insurance (Insurance Fund).
Minor costs to review health plan filings and take enforcement
actions, as necessary, by the Department of Managed Health
Care (Managed Care Fund).
Ongoing costs of about $200,000 per year for increased
utilization of covered topical ophthalmic products by Medi-Cal
beneficiaries (General Fund and federal funds). The California
Health Benefits Review Program analyzed a prior version of the
bill that would have required early refills at 70% of
AB 1831 (Low) Page 1 of
?
predicted use days. Based on the current version of the bill,
which requires early refills at 76% - 77% of predicted days,
the costs to the Medi-Cal program are likely to be about
one-half of the previously projected costs.
Minor costs to the CalPERS due to increased prescription drug
benefit costs (various funds). Similar to the costs projected
for the Medi-Cal program, the costs of the current bill are
likely to be about one-half of the previously projected costs.
No state cost to subsidize health care coverage through
Covered California is anticipated. Under federal law, any new
mandated health benefit that exceeds the benefits in the
state's essential health benefits benchmark plan would be a
state responsibility. In other words, to the extent that the
state imposes a new benefit mandate that exceeds the essential
health benefits benchmark, the state would be responsible for
paying for the cost to subsidize that benefit for those
individuals who are receiving subsidized coverage through
Covered California. Because this bill does not mandate a new
benefit, but only change the terms of an existing benefit
(prescription drugs), the bill is not expected to result in
the state being responsible for subsidizing coverage.
Background: Under current law, health insurers are regulated by the
Department of Insurance and health plans are regulated by the
Department of Managed Health Care.
The federal Affordable Care Act and implementing legislation
enacted in California make a variety of changes to the
individual and group health insurance market. Changes to the
market include a requirement for "guaranteed issue" of coverage
if premiums are paid, a prohibition on denials of coverage for
preexisting conditions, and many other regulatory requirements.
In addition, non-grandfathered plans are required to provide
specified essential health benefits, including coverage of
prescription drugs.
Topical ophthalmic products (prescription eye drops) are used to
treat a variety of conditions of the eye, either acute
conditions or chronic conditions. Unlike prescription drugs
taken in pill form, a patient may have difficulty accurately
AB 1831 (Low) Page 2 of
?
dropping the required number of drops into one or both eyes.
Therefore, there is a greater likelihood that accidentally
putting too many drops into the eye or missing the eye will
result in wastage of the product. In such cases, the patient may
run out of the product before the next prescription refill is
allowed. According or information included in the California
Health Benefits Review Program analysis of this bill, the
published literature indicates that 25% of sampled glaucoma
patients report experiencing early exhaustion of their
ophthalmic product and 5% report early exhaustion five or more
times per year.
Proposed Law:
AB 1831 would require health insurers and health plans to
provide coverage for early refills of prescription topical
ophthalmic products.
Specific provisions of the bill would:
Require a health plan contract or health insurance contract
issued or renewed after July 1, 2017 that provides
prescription drug coverage to allow early refills of topical
ophthalmic products;
For a 30-day supply, allow an early refill at least 23 days
from the original prescription or latest refill (77% of
expected days);
For a 90-day supply, allow an early refill at least 68 days
from the original prescription or latest refill (76% of
expected days);
Prohibit a requested early refill from exceeding the
additional quantities prescribed by the provider (e.g. the
allowed refills on the prescription);
Specify that the bill does not prevent a health insurer or
health plan from allowing early refills at 70% of expected
days;
Specify that the bill shall not be construed to establish a
new benefit mandate or prevent the application of a deductible
or copayment.
Related
Legislation: AB 2418 (Bonilla, 2014) included language similar
to the contents of this bill, amongst other benefit mandate
requirements. That bill was vetoed by Governor Brown. However,
the Governor's veto message did not reference the portions of AB
AB 1831 (Low) Page 3 of
?
2418 that are included in this bill.
Staff
Comments: According to the California Health Benefits Review
Program, the bill is likely to improve adherence amongst
patients who are generally adherent to their medical advice, but
who face a gap in use due to wastage of their existing
prescription. The Program found that there is not sufficient
evidence to determine whether the modest increase in medical
adherence possible with early refills would measurably impact
the effectiveness of treatments.
The only costs that may be incurred by a local agency relate to
crimes and infractions. Under the California Constitution, such
costs are not reimbursable by the state.
-- END --