BILL ANALYSIS Ó
AB 2115
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CONCURRENCE IN SENATE AMENDMENTS
AB
2115 (Wood)
As Amended August 17, 2016
Majority vote
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|ASSEMBLY: |71-0 |(May 23, 2016) |SENATE: | 36-3 |(August 22, |
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Original Committee Reference: HEALTH
SUMMARY: Requires health care service plans (health plans) and
health insurers, when notifying enrollees who cease to be
enrolled in health plans or insurance products about other
health care coverage options, to also provide information on
low- or no-cost programs for health care and prescription
medicines on the Office of Patient Advocate (OPA) Web site.
The Senate amendments:
1)Delete language with respect to free or reduced cost
prescription medicine through a manufacturer's patient
assistance program (PAP) as part of the health plan and health
insurer notice to enrollees who cease to be enrolled in health
plans or insurance products.
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2)Delete notice language specifying that the manufacturer PAP
does not constitute coverage under the federal Patient
Protection and Affordable Care Act (ACA).
3)Add notice language indicating that additional information on
low- or no-cost programs for health care and prescription
medicines may be found on the OPA Web site or the Internet Web
site determined to be the most appropriate to contain this
information, effective January 1, 2018.
4)Clarify language indicating no later than July 1, 2017, the
Department of Managed Health Care, in consultation with the
Office of the Patient Advocate, the Department of Insurance,
and the California Health Benefit Exchange, to develop the
statement to be included in the notice.
5)Delete language requiring the Department of Managed Health
Care (DMHC) and California Department of Insurance (CDI) to
including notice information on locating free or reduced cost
programs for health care and prescription medicines, such as
through OPA's Web site.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS: According to the author, despite California's
implementation of the ACA, which created or expanded coverage
options for many Californians, gaps remain - with an estimated
3.8 million Californians under age 65 remaining without
coverage. Compared to their insured counterparts, California's
uninsured have reported having a significantly lower health
status and a substantially higher rate of not seeking care due
to cost concerns. Nationwide, an estimated 125,000 deaths per
year and between 33 and 69% of medication-related hospital
admissions are a result of patients not getting or taking a
prescribed medicine in a timely manner. Washington State
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established a program using navigators and online resources to
assist consumers in finding appropriate PAPs for their
respective situations and medication needs, handling over 41
million prescriptions since 2009. A recent study of the
Washington program found that patients receiving assistance in
finding appropriate programs had nearly half the number of
emergency department and hospital encounters as those not
receiving such assistance. In helping to ensure Californians
leaving coverage understand the programs available to them for
free and reduced cost medicines, this bill will help to reduce
the potential negative health impact that delays in access to
prescribed medicines can cause.
According to the National Conference of State Legislatures, PAPs
has been a substantial and growing state interest for a number
of years, generally in response to individuals who lack
insurance coverage for medicines or who were not eligible for
other government programs. In 1975, the first states began to
authorize and fund direct subsidy programs. By 2009, a total of
at least 42 states had established or authorized some type of
program to provide pharmaceutical coverage or assistance;
several of those are not currently operational. The subsidy
programs, often termed "SPAPs," utilize state funds to pay for a
portion of the drug costs, usually for a defined population that
meets enrollment criteria. In addition, an increasing number of
states use discounts or bulk purchasing approaches that do not
spend state funds for the drug purchases, identified as
"Discount Programs." Since the passage of the ACA, state
legislatures have been less active on SPAP issues.
Analysis Prepared by: Kristene Mapile / HEALTH / (916)
319-2097 FN: 0004542
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