BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2115


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          GOVERNOR'S VETO


          AB  
          2115 (Wood)


          As Enrolled  September 2, 2016


          2/3 vote


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          |ASSEMBLY:  |71-0  |(May 23, 2016) |SENATE: |36-3  |(August 22,      |
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          |ASSEMBLY:  |72-0  |(August 25,    |        |      |                 |
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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.  








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          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.  


          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 and California Department of Insurance 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  








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          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  
          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  








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          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.


          GOVERNOR'S VETO MESSAGE:


          I am returning Assembly Bill 2115 without my signature.


          Existing law requires health plans and insurers to notify  
          individuals who will no longer be covered by that plan or  
          insurer that they may be eligible for low or no-cost health  
          coverage through Covered California or Medi-Cal.  This bill adds  
          to the notice a statement that information about low or no-cost  
          health care and prescription medicines may be found on a website  
          that is to be determined. 


          I believe the current notification requirements are sufficient.




          Analysis Prepared by:                                             
                          Kristene Mapile / HEALTH / (916) 319-2097  FN:  
          0005098
















                                                                    AB 2115


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