Amended in Senate June 6, 2016

Amended in Assembly March 18, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 2050


Introduced by Assembly Member Steinorth

February 17, 2016


An act to add Section 1367.248 to the Health and Safety Code, and to add Section 10123.208 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 2050, as amended, Steinorth. 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 contracts and policies that cover prescription drug benefits. Existing law, the Pharmacy Law, provides for the licensure and regulation of pharmacists by the California State Board of Pharmacy and prohibits the refilling of a prescription without the authorization of the prescriber, except as specified.

This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2017, that provides coverage for prescription drug benefits to implement a medication synchronizationbegin delete policyend deletebegin insert programend insert for the dispensing of prescription drugsbegin insert by a single retail network pharmacyend insert so that prescriptions that are refilled at the same frequency may be filledbegin delete concurrently.end deletebegin insert concurrently for the purpose of improving medication adherence or if it is in the best interest of the enrollee or insured, as specified.end insert 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:

P2    1

SECTION 1.  

Section 1367.248 is added to the Health and
2Safety Code
, to read:

3

1367.248.  

(a) A health care service plan contract issued,
4amended, or renewed on or after January 1, 2017, that provides
5coverage for prescription drug benefits shall implement a
6synchronizationbegin delete policyend deletebegin insert programend insert for the dispensing of prescription
7drugs to begin deletethe plan’send delete enrollees.

begin delete

8(b) For purposes of this section, “synchronization policy” means
9a procedure for aligning the refill dates of an enrollee’s prescription
10drugs so that prescriptions that are refilled at the same frequency
11may be refilled concurrently.

end delete
begin insert

12
(b) In implementing the synchronization program pursuant to
13this section, all of the following shall apply:

end insert
begin insert

14
(1) The plan shall not deny coverage for a prescription drug
15covered by the health care service plan contract that is dispensed
16by a network pharmacy for less than the standard refill amount
17for the purpose of improving medication adherence or if the
18enrollee agrees that synchronizing his or her medications is in his
19or her best interest.

end insert
begin insert

20
(2) The plan shall accept early refill and short-fill requests for
21prescription drugs using the submission clarification and message
22codes adopted by the National Council for Prescription Drug
23Programs or alternative codes provided by the plan.

end insert
begin insert

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(3) The plan may apply a prorated daily cost-sharing rate for
2maintenance prescription drugs that are dispensed by a network
3pharmacy for the purpose of synchronizing the enrollee’s
4medications.

end insert
begin insert

5
(4) The plan may impose a limit on the number of
6synchronization attempts in a contract year. The limit may be
7established by the plan in an amount of not less than four attempts
8per year.

end insert
begin insert

9
(c) For purposes of this section, “synchronization program”
10means a procedure for aligning the refill dates of an enrollee’s
11prescription drugs that are being dispensed by a single retail
12network pharmacy so that prescriptions that are refilled at the
13same frequency may be refilled concurrently for the purpose of
14improving medication adherence or if it is in the best interest of
15the enrollee.

end insert
begin insert

16
(d) This section does not apply to any of the following:

end insert
begin insert

17
(1) A prescription drug that is in unit-of-use packaging for which
18synchronization is not possible.

end insert
begin insert

19
(2) A prescription drug that is subject to quantity limits or other
20utilization management controls that are inconsistent with the
21synchronization program, including, but not limited to, controlled
22substance prescribing and special dispensing requirements or
23guidelines intended to prevent misuse or abuse.

end insert
begin insert

24
(3) A prescription drug that the patient has been taking for less
25than 90 consecutive calendar days.

end insert
begin insert

26
(e) The coverage required by this section may be limited by
27formulary restrictions applied to a prescription drug by a health
28care service plan.

end insert
29

SEC. 2.  

Section 10123.208 is added to the Insurance Code, to
30read:

31

10123.208.  

(a) A health insurance policy issued, amended, or
32renewed on or after January 1, 2017, that provides coverage for
33prescription drug benefits shall implement a synchronizationbegin delete policyend delete
34begin insert programend insert for the dispensing of prescription drugs tobegin delete the policy’s
35insuredend delete
begin insert insuredsend insert.

begin delete

36(b) For purposes of this section, “synchronization policy” means
37a procedure for aligning the refill dates of an insured’s prescription
38drugs so that prescriptions that are refilled at the same frequency
39may be refilled concurrently.

end delete
begin insert

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(b) In implementing the synchronization program pursuant to
2this section, all of the following shall apply:

end insert
begin insert

3
(1) The insurer shall not deny coverage for a prescription drug
4covered by the health insurance policy that is dispensed by a
5network pharmacy for less than the standard refill amount for the
6purpose of improving medication adherence or if the insured
7agrees that synchronizing his or her medications is in his or her
8best interest.

end insert
begin insert

9
(2) The insurer shall accept early refill and short-fill requests
10for prescription drugs using the submission clarification and
11message codes adopted by the National Council for Prescription
12Drug Programs or alternative codes provided by the insurer.

end insert
begin insert

13
(3) The insurer may apply a prorated daily cost-sharing rate
14for maintenance prescription drugs that are dispensed by a network
15pharmacy for the purpose of synchronizing the insured’s
16medications.

end insert
begin insert

17
(4) The insurer may impose a limit on the number of
18synchronization attempts in a contract year. The limit may be
19established by the insurer in an amount of not less than four
20attempts per year.

end insert
begin insert

21
(c) For purposes of this section, “synchronization program”
22means a procedure for aligning the refill dates of an insured’s
23prescription drugs that are being dispensed by a single retail
24network pharmacy so that prescriptions that are refilled at the
25same frequency may be refilled concurrently for the purpose of
26improving medication adherence or if it is in the best interest of
27the insured.

end insert
begin insert

28
(d) This section does not apply to any of the following:

end insert
begin insert

29
(1) A prescription drug that is in unit-of-use packaging for which
30synchronization is not possible.

end insert
begin insert

31
(2) A prescription drug that is subject to quantity limits or other
32utilization management controls that are inconsistent with the
33synchronization program, including, but not limited to, controlled
34substance prescribing and special dispensing requirements or
35guidelines intended to prevent misuse or abuse.

end insert
begin insert

36
(3) A prescription drug that the patient has been taking for less
37than 90 consecutive calendar days.

end insert
begin insert

38
(e) The coverage required by this section may be limited by
39formulary restrictions applied to a prescription drug by a health
40insurer.

end insert
P5    1

SEC. 3.  

No reimbursement is required by this act pursuant to
2Section 6 of Article XIII B of the California Constitution because
3the only costs that may be incurred by a local agency or school
4district will be incurred because this act creates a new crime or
5infraction, eliminates a crime or infraction, or changes the penalty
6for a crime or infraction, within the meaning of Section 17556 of
7the Government Code, or changes the definition of a crime within
8the meaning of Section 6 of Article XIII B of the California
9Constitution.



O

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