BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 999|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: SB 999
Author: Pavley (D), et al.
Amended: 4/18/16
Vote: 21
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 7-0, 4/4/16
AYES: Hill, Block, Galgiani, Hernandez, Jackson, Mendoza,
Wieckowski
NO VOTE RECORDED: Bates, Berryhill
SENATE HEALTH COMMITTEE: 7-1, 4/13/16
AYES: Hernandez, Hall, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nielsen
NO VOTE RECORDED: Nguyen
SENATE APPROPRIATIONS COMMITTEE: 5-1, 5/16/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Nielsen
NO VOTE RECORDED: Bates
SUBJECT: Health insurance: contraceptives: annual supply
SOURCE: California Family Health Council
NARAL Pro-Choice California
Planned Parenthood Affiliates of California
DIGEST: This bill 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.
ANALYSIS:
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Existing law:
1) Establishes the Board of Pharmacy 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.
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) Does not require a provider to prescribe, furnish, or
dispense 12 months of SAHC at one time.
6) Does not require a policy or health care service plan to
cover contraceptives provided by an out-of-network provider,
pharmacy, or location licensed or otherwise authorized to
dispense drugs or supplies, except as may be otherwise
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authorized by state or federal law or by the insurer's
policies governing out-of-network coverage.
7) 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 up to a 12-month supply of FDA-approved SAHC when
dispensed at one time for an insured or an enrollee by a
provider, pharmacist, or at a location licensed or otherwise
authorized to dispense drugs or supplies.
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 minorities of women have complications from SAHCs, such
as blood clots, ACOG 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
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results were to be borne across the state, significant
individual health benefits and financial savings could be
realized by preventing unintended pregnancies.
Endorsements and Other States' Practices
The United States Centers for Disease Control 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."
ACOG recommended that payment and practice policies support
providing individuals with a 3- to 13-month supply of oral
contraceptives in January 2015.
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.
Oregon and the District of Columbia passed laws in 2015
authorizing a 12-month supply of SAHC.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Senate Appropriations Committee analysis dated
May 2, 2016, this bill will result in minor costs to review
information from health insurers by the Department of Insurance
and annual premium savings to the California Public Employees'
Retirement System of about $2 million per year due to reduced
health care costs associated with unintended pregnancies. This
bill is not anticipated to result in significant costs to review
health plan information by the Department of Managed Health Care
(Managed Care Fund), there are no significant costs or savings
projected for the Medi-Cal program and no state costs to
subsidize coverage through Covered California are anticipated.
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SUPPORT: (Verified5/17/16)
California Family Health Council (co-source)
NARAL Pro-Choice California (co-source)
Planned Parenthood Affiliates of California (co-source)
Alameda County Board of Supervisors
American Civil Liberties Union
American Congress of Obstetricians and Gynecologists, District
IX California
American Medical Women's Association
Asian Law Alliance
Bayer Corporation
Black Women for Wellness
California Academy of Family Physicians
California Academy of Physician Assistants
California Medical Association
California Pan-Ethnic Health Network
California Primary Care Association
California Religious Coalition for Reproductive Choice
California Women's Law Center
El Proyecto del Barrio, Inc.
Forward Together
Health Access of California
Jewish Family Support Services
March of Dimes Foundation
National Association of Social Workers, California Chapter
Physicians for Reproductive Health
Planned Parenthood Action Fund of the Pacific Southwest
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Northern California Action Fund
OPPOSITION: (Verified5/17/16)
America's Health Insurance Plans
Association of California Life and Health Insurance Companies
California Association of Health Plans
California Catholic Conference, Inc.
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California Right to Life Committee
ARGUMENTS IN SUPPORT: Supporters like Planned Parenthood
Affiliates of California believe 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. Supporters
states that 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%.
ARGUMENTS IN OPPOSITION: Opponents do not believe that
dispensing a full year of birth control at one time is a
practical solution and state that the consequences of this bill
could very well result in the duplication of coverage by
different insurers, and an increase in wasted medication.
Opponents are also 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 and without incorporating a mandatory trial period, it is
inevitable that there will be 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. Opponents state that the 12-month supply would
likely end up either partially used or altogether unused, which
inevitably would increase the amount of pharmaceutical waste.
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
5/18/16 16:27:53
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