BILL ANALYSIS Ó
SB 999
Page 1
Date of Hearing: August 3, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SB 999
(Pavley) - As Amended August 1, 2016
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|Policy |Health |Vote:|13 - 0 |
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| |Business and Professions | |13 - 2 |
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY:
This bill requires coverage for up to a 12-month supply of Food
and Drug Administration-approved, self-administered hormonal
contraceptives (contraceptives) and permits pharmacists to
dispense these contraceptives consistent with existing protocols
and upon a patient's request.
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FISCAL EFFECT:
1)According to the California Health Benefits Review Program
(CHBRP), this bill will result in overall health savings in
the health care industry due to reduced office visits and
reduced unintended pregnancies, which will reduce prenatal
care, abortions, and labor and delivery costs. Costs by payer
are as follows:
a) No significant costs or savings to Medi-Cal managed care
(GF/federal). CHBRP notes utilization of hormonal
contraceptives by Medi-Cal enrollees is not expected to
increase significantly, because Medi-Cal already covers up
to a 12-month supply of oral contraceptives and utilization
of the other covered forms of contraception is very low.
Therefore, there is no significant increase in utilization
anticipated nor is there an anticipated reduction in health
care services related to unintended pregnancy.
b) Annual premium cost savings to CalPERS of about $2
million per year, due to reduced health care costs
associated with unintended pregnancies (GF/ special/
federal/ local). Cost savings are split approximately 50-50
between state and local government.
c) Annual employer-funded premium cost savings in the
private insurance market of approximately $12.5 million.
d) Decreased premium expenditures by employees and
individuals purchasing insurance of $9.4 million, and
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reduced total out-of-pocket expenses of $18.7 million.
2)The Department of Health Care Services notes an impact to
fee-for-service Medi-Cal and Family Planning Access to Care
and Treatment (Family PACT) in the amount of $38.3 million
($7.9 million GF/remainder federal). Based on CHBRP's
analysis of the impact of a 12-month supply on unintended
pregnancies, this cost appears likely to be fully offset by
reductions in costs for unintended pregnancies, office visits,
abortions, and other services.
3)Minor costs to the California Department of Insurance
(Insurance Fund) and the Department of Managed Health Care
(Managed Care Fund) to verify plans and insurers comply with
this requirement.
COMMENTS:
1)Purpose. This bill seeks to reduce gaps in birth control use
by facilitating adherence to prescription contraceptives. The
author notes it can be difficult and burdensome for women,
particularly those who are low-income and/or live in rural
areas, to visit a pharmacy every month or 90 days to refill
prescriptions for contraceptives. The author notes a recent
study found women who received a full year's worth of birth
control pills at one time were 30% less likely to have an
unintended pregnancy than women who received a one-month or
three-month supply.
2)Background. Current law limits dispensing of drugs at
pharmacies to a maximum of a 90-day supply. Dispensing
12-month supplies of contraceptives has been recommended by
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experts and has been allowed in some state Medicaid programs
and state family planning programs, including California's
Medi-Cal and Family PACT programs, which currently provide
12-month supplies of oral contraceptives. In 2013, the federal
Centers for Disease Control and Prevention recommended that
women be provided with 12-month supplies of self-administered
hormonal contraceptives, and in January 2015, American
Congress of Obstetricians and Gynecologists also issued
guidelines that recommended payment and practice policies that
support such annual dispensing. A number of other states have
12-month dispensing laws, or have such laws under
consideration.
3)CHBRP Findings. Currently, most contraceptives are dispensed
in a 30-day supply, while about a third are dispensed in a
90-day supply. As a result of this bill, CHBRP estimates a
decrease in unintended pregnancies of 15,000 (which includes
6,000 fewer live births, 2,000 fewer miscarriages, and 7,000
fewer abortions). CHBRP projects this bill would also result
in a decrease in the rate of unintended pregnancies over the
long term, reducing negative outcomes associated with
unintended pregnancies for both mothers and children. CHBRP
also notes avoiding unintended pregnancies also helps women to
delay childbearing and pursue additional education, spend
additional time in their careers, and have increased earning
power.
4)Support. This bill is sponsored by Planned Parenthood
Affiliates of California, NARAL Pro-Choice California, and the
California Family Health Council, who believe this bill will
reduce burdens on women, as well as lead to more consistent
contraceptive use and fewer unintended pregnancies.
5)Opposition. The Association of California Life and Health
Insurance Companies (ACLHIC) and California Association of
Health Plans (CAHP) are opposed unless amended, seeking
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amendments to allow an insurer to request that a patient be
stabilized on the medication prior to the 12-month supply
being filled as well as a one-year implementation delay. The
California Right to Life Committee is in opposition.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081