BILL ANALYSIS Ó
AB 2752
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Date of Hearing: May 4, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2752 (Nazarian) - As Amended April 26, 2016
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|Policy |Health |Vote:|14 - 3 |
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY:
This bill requires health plans and insurers to include, in
annual renewal materials, a notice to enrollees that a
prescription drug is no longer covered by the plan or has
changed tiers in the plan's drug formulary, if that is the case.
It also requires inclusion of information regarding a provider
directory or directories.
FISCAL EFFECT:
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Estimated costs to the Department of Managed Health Care of
$65,000 for the first year to assess the plans' processes,
policies, and procedures for identifying providers, drugs, and
impacted enrollees, and $390,000 in future years for enforcement
(Managed Care Fund). Ongoing costs in any given year could be
higher or lower depending on compliance and the level of
enforcement activity.
COMMENTS:
1)Purpose. The author of this bill states that for people with
serious and chronic conditions, making sure that the health
insurance plan they choose covers the prescription drugs they
need is important. This bill also builds upon recent
legislation relating to provider directories and requires the
plan or insurer to provide information about the plan's or
insurer's provider directories.
2)Provider directories. Existing law imposes requirements
related to provider directories. SB 137 (Hernandez), Chapter
649, Statutes of 2015, beginning July 1, 2016, requires DMHC
and the California Department of Insurance to develop uniform
provider directory standards. The bill also requires a health
plan or insurer to ensure the accuracy of the information
contained in the directory or directories, and requires the
plan or insurer, at least annually, to review and update the
entire provider directory or directories for each product
offered. Finally, it requires a health plan or health
insurer, at least weekly, to update its online provider
directory or directories, and requires a plan or insurer, at
least quarterly, to update its printed provider directory or
directories.
3)Prescription drugs. Existing law imposes requirements related
to drug benefits, including transparency about what is
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covered. AB 339 (Gordon), Chapter 619, Statutes of 2015,
standardizes prescription drug tiers and setting cost-sharing
limits. Additionally, SB 1052 (Torres), Chapter 575, Statutes
of 2014, requires health plans and insurers to use a standard
drug formulary template to display their drug formularies and
to post their formularies on their Web sites. This recent
legislation is currently being implemented.
4)Support. California Chronic Care Coalition (CCCC), the sponsor
of this bill, states that this bill will fill a continuity of
care gap by providing an important information tool for
consumers to better understand health plan changes. CCCC
additionally states that this bill takes the first step to
ensure, at least at the point of plan or policy renewal, that
an enrollee or insured is notified of formulary and network
changes.
5)Opposition. Blue Shield of California opposes this bill,
citing lack of necessity and an increase in administrative
activities that will not add value. They also state current
law requires health plans to notify a member when a drug is
moved from formulary to non-formulary.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
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