BILL ANALYSIS Ó
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2015 - 2016 Regular
Bill No: SB 999 Hearing Date: April 4,
2016
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|Author: |Pavley |
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|Version: |March 29, 2016 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Sarah Huchel |
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Subject: Health insurance: contraceptives: annual supply
SUMMARY: Authorizes a pharmacist to dispense a 12-month supply of
United States Food and Drug Administration (FDA)-approved,
self-administered hormonal contraceptives (SAHC) and requires
insurance to cover the cost.
Existing law:
1) Establishes the Board of Pharmacy (BOP) to administer the
Pharmacy Law. (Business and Professions Code (BPC) Sections
4000 et seq.)
2) Authorizes a pharmacist to dispense a 90-day supply of a
dangerous drug other than a controlled substance pursuant to
a valid prescription that specifies an initial quantity of
less than a 90-day supply under certain circumstances.
Prohibits a pharmacist from dispensing a greater supply if
the prescriber indicates otherwise. (BPC § 4064.5)
3) Authorizes a pharmacist to furnish SAHC in accordance with
standardized procedures or protocols. (BPC § 4052.3)
This bill:
1) Makes findings related to the benefits of providing a
12-month supply of FDA-approved SAHC.
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2) Provides an exception to the prohibition on pharmacists
dispensing no more than a 90-day supply of a dangerous drug
for FDA-approved SAHC.
3) Requires that a prescription for FDA-approved SAHC be
dispensed as provided on the prescription, including, but not
limited to, a prescription for a 12-month supply.
4) Authorizes a pharmacist furnishing FDA-approved SAHC pursuant
to a protocol to dispense, at the patient's request, up to a
12-month supply at one time.
5) Requires every health care service plan contract and every
group or individual policy of disability insurance, except
for a specialized health insurance policy, that is issued,
amended, renewed, or delivered on or after January 1, 2017,
to cover a
12-month supply of FDA-approved SAHC dispensed by a prescriber
or pharmacy at one time to an enrollee.
6) States that if a 12-month supply of FDA-approved SAHC is
dispensed onsite at a location licensed or otherwise
authorized to dispense drugs or supplies, the health care
service plan or insurer shall cover the 12-month supply.
7) States that no reimbursement is required by this bill
pursuant to the California Constitution.
FISCAL
EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill is sponsored by Planned Parenthood
Affiliates of California, California Family Health Council,
and NARAL Pro-Choice California. According to the Author,
"This bill seeks to address the lack of consistent access to
prescription contraception in California. California has
required insurance coverage for prescription medications since
1998, but many hurdles to providing consistent coverage
remain.
"Specifically, this bill addresses current barriers to
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obtaining consistent, uninterrupted contraception. Under
current law, health insurance companies and plans must limit
their coverage of birth control to a one- or three- month
supply. This practice can lead to unwanted gaps in birth
control use and an increased incidence of unintended
pregnancies. Inadequate supplies of birth control are
particularly problematic for many women who have
unpredictable work hours, difficulty accessing
transportation, or other barriers preventing them from
getting to a pharmacy or clinic."
2.Background. Pharmacies are constrained by state law from
providing more than a three-month supply of SAHC pursuant to a
prescription. However, certain clinics that dispense SAHC
through a Medi-Cal program, Family Planning, Access, Care and
Treatment (PACT), may provide up to a year's supply. This
provided an ideal environment to study the effects of an
increase in SAHC supply on unintended pregnancies.
The results were published in a 2011 edition of Obstetrics
and Gynecology, the medical journal of the American College
of Obstetricians and Gynecologists (ACOG). In the "Number of
Oral Contraceptive Pill Packages Dispensed and Subsequent
Unintended Pregnancies," researchers found that women who
received a full year's worth of pills at one time were 30
percent less likely to have an unintended pregnancy than
women who received either a one-month or three-month supply
of pills. There was no definitive reason for this reduction
in unintended pregnancies, but analysts believe that several
factors contributed including: (1) having a larger supply on
hand reduced the opportunity for lapse in dosages due to the
need to restock, and (2) each visit to get more SAHC was an
opportunity to reconsider taking it -- an extensive supply
reinforced the idea that this method of birth control was
effective and safe.
Although a minority of women have complications from SAHCs,
such as blood clots, AGOG determined in a 2012 report that
the risk of getting a blood clot from a SAHC is less than it
is for a clot during or immediately following pregnancy. If
these results were to be borne across the state, significant
individual health benefits and financial savings could be
realized by preventing unintended pregnancies.
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3.Endorsements and Other States' Practices.
a) The United States Centers for Disease Control (CDC)
recommended that women be provided with a year's supply of
SAHC in its publication, "U.S. Selected Practice
Recommendations for Contraceptive Use, 2013: Adapted from
the World Health Organization Selected Practice
Recommendations for Contraceptive Use, 2nd Edition."
b) ACOG recommended that payment and practice policies
support providing individuals with a 3- to 13-month supply
of oral contraceptives in January 2015.
c) On February 5, 2015, the California Department of Health
Care Services began requiring all Medi-Cal managed care and
their delegates to pay for 12 month dispensing for SAHC.
d) Oregon and the District of Columbia passed laws in 2015
authorizing a 12 month supply of SAHC.
4.Arguments in Support. Planned Parenthood Affiliates of
California write, "On behalf of Planned Parenthood Affiliates
of California and the more than 115 health centers throughout
the state, we are pleased to support SB 999 (Pavley). This
bill would require all health care service plans and health
insurers to cover up to
12-months of FDA-approved self-administered hormonal
contraceptives when dispensed at one time.
"This bill will improve access to contraceptives by allowing
a woman to receive a year's supply of prescribed hormonal
contraceptives rather than requiring her to return every 30
to 90 days to obtain a refill. For birth control to be
effective, consistency is essential. For many women,
particularly those who live in low income rural areas,
receiving only short supply of contraception can impede their
ability to use birth control on a consistent basis.
Additionally, studies show that dispensing a 12-month supply
of birth control at one time reduces a woman's odds of having
an unintended pregnancy by 30%.
"This bill makes dispensing a 12-month supply of birth
control a best practice in the commercial and Medi-Cal
managed care settings and for these reasons, we strongly
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support SB 999 (Pavley) and urge your AYE vote when it is
heard in the Senate Business, Professions and Economic
Development Committee."
5.Arguments in Opposition. The California Catholic Conference,
Inc. writes,
"SB 999 would reduce the standard of care for women seeking help
and information regarding the variety of proven contraception
methods available. If the author's rationale for this bill is
to reduce the number of pregnancies in our state, then women
ought to also be made aware of other safe and effective
pregnancy-prevention methods, such as natural family planning,
which is a medically endorsed tool for couples to making
parenting decisions, especially those struggling with
contraceptive-related infertility issues. Natural techniques
respect the dignity of the human person through emphasizing
shared responsibility, intimate communication, and mutual
respect."
Association of California Life and Health Insurance Companies
writes, "While we appreciate the author's intent and are
supportive of medication adherence, we do not believe that
dispensing a full year of birth control at one time is a
practical solution. The consequences of this measure could
very well result in the duplication of coverage by different
insurers, and an increase in wasted medication.
"Additionally, for similar reasons as stated above, we are
concerned that the bill does not specify that for new
medication, an insurer may require a patient to try an initial
30 or 90 day supply prior to filling the 12 month supply.
Without incorporating a mandatory trial period, it is
inevitable that we will see a rise in unused medication as
some women will choose to switch medications due to unexpected
side effects, or even a change in the desire or need to use
contraceptives. In all of these instances the 12 month supply
would likely end up either partially used or altogether
unused, which inevitably would increase the amount of
pharmaceutical waste."
6.Related Legislation. SB 1193 (Hill) extends the sunset date
on the BOP until 2021. ( Status : This bill is pending in
Senate Business, Professions and Economic Development
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Committee.)
7.Prior Related Legislation. SB 493 (Hernandez, Chapter 469,
Statutes of 2013) expanded the scope of practice of a
pharmacist to recognize an "advanced practice pharmacist";
permited pharmacists to furnish certain hormonal
contraceptives, nicotine replacement products, and
prescription medications for travel, as specified; and
authorized pharmacists to independently initiate and
administer certain vaccines and treatments for severe allergic
reactions.
NOTE : Double-referral to the Senate Committee on Health which will
address the health insurance implications of this measure.
SUPPORT AND OPPOSITION:
Support of bill as introduced 2/10/16:
Planned Parenthood Affiliates of California (Sponsor)
California Family Health Council (Sponsor)
NARAL Pro-Choice California (Sponsor)
American Civil Liberties Union of California
American College of Obstetricians and Gynecologists
American Medical Women's Association
Asian Law Alliance
Bayer
California Academy of PAs
California Medical Association
California Primary Care Association
California Religious Coalition for Reproductive Choice
California Women's Law Center
Citizens for Choice
Community Action Fund of Planned Parenthood of Orange and San
Bernardino
Counties
Health Access California
National Association of Social Workers, California Chapter
Physicians for Reproductive Health
Planned Parenthood Action Fund of Santa Barbara, Ventura, and
San Luis Obispo
Planned Parenthood Advocates Pasadena and San Gabriel Valley
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Planned Parenthood Mar Monte
Planned Parenthood Northern California Action Fund
Opposition to bill as introduced 2/10/16:
Association of California Life and Health Insurance Companies
California Association of Health Plans
California Catholic Conference, Inc.
California Right to Life Committee
America's Health Insurance Plans
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