BILL ANALYSIS Ó
AB 1831
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GOVERNOR'S VETO
AB
1831 (Low)
As Enrolled August 30, 2016
2/3 vote
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|ASSEMBLY: |71-8 |(June 1, 2016) |SENATE: |37-0 |(August 17, |
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|ASSEMBLY: |80-0 |(August 23, | | | |
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Original Committee Reference: HEALTH
SUMMARY: Requires health care service plans (health plans) and
health insurers to provide coverage for early refills of
prescription topical ophthalmic products (TOPs).
The Senate amendments:
AB 1831
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1)Add language delaying implementation until July 1, 2017.
2)Delete language allowing for early refills of TOPs at 70% of
the predicted days of use.
3)Add language specifying standards for early refills of TOPs:
a) For a 30-day supply, at least 23 days and less than 30
days from the later of either of the following:
i) The original date that the prescription was
distributed to the enrollee or insured; or,
ii) The date of the most recent refill that was
distributed to the enrollee or insured.
b) For a 90-day supply, at least 68 days and less than 90
days from the later of either of the following:
i) The original date that the prescription was
distributed to the enrollee or insured; or,
ii) The date of the most recent refill that was
distributed to the enrollee or insured.
4)Add language prohibiting an enrollee or insured's refill
request from exceeding the number of additional quantities
prescribed by the enrollee or insured's participating health
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plan or health insurer provider.
5)Add language specifying that this bill does not prevent a
health plan contract or health policy from allowing for early
refills at or below 75% of the predicted days of use.
FISCAL EFFECT: According to the Senate Appropriations
Committee,
1)Minor costs to review health insurer filings and take
enforcement actions, as necessary, by the Department of
Insurance (Insurance Fund).
2)Minor costs to review health plan filings and take enforcement
actions, as necessary, by the Department of Managed Health
Care (Managed Care Fund).
3)Ongoing costs of about $200,000 per year for increased
utilization of covered TOPs by Medi-Cal beneficiaries (General
Fund and federal funds). The California Health Benefits
Review Program analyzed a prior version of this bill that
would have required early refills at 70% of predicted use
days. Based on the current version of this 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.
4)Minor costs to the California Public Employees' Retirement
System due to increased prescription drug benefit costs
(various funds). Similar to the costs projected for the
Medi-Cal program, the costs of this bill are likely to be
about one-half of the previously projected costs.
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5)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), this bill is not expected to result in
the state being responsible for subsidizing coverage.
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.
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.
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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
and permit physicians to authorize earlier refills for
particular beneficiaries who continue to have difficulty with
inadvertent wastage.
GOVERNOR'S VETO MESSAGE:
I am returning Assembly Bill 1831 without my signature.
This bill requires health plans and insurance policies to pay
for early refills of medicated eye drops.
Applying eye drops is sometimes difficult and imprecise.
However, in most instances of spillage or loss, health plans or
pharmacists provide an early refill to those who need it.
Moreover, new mandates, even small ones, add to the high cost of
health care.
Analysis Prepared by: Kristene Mapile / HEALTH / (916)
319-2097 FN: 0005103
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