BILL ANALYSIS Ó
SB 999
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SENATE THIRD READING
SB
999 (Pavley)
As Amended August 1, 2016
Majority vote
SENATE VOTE: 29-6
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |13-0 |Wood, Maienschein, | |
| | |Bonilla, Campos, | |
| | |Chiu, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Olsen, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Thurmond, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Business & |13-2 |Salas, Baker, Bloom, |Brough, Jones |
|Professions | |Campos, Chávez, Dodd, | |
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| | |Eggman, Gatto, Gomez, | |
| | |Holden, Mullin, Ting, | |
| | |Wood | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |15-3 |Gonzalez, Bloom, |Bigelow, Jones, |
| | |Bonilla, Bonta, |Wagner |
| | |Calderon, Daly, | |
| | |Eggman, Eduardo | |
| | |Garcia, Holden, | |
| | |Obernolte, Quirk, | |
| | |Santiago, Weber, | |
| | |Wood, Chau | |
| | | | |
| | | | |
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SUMMARY: Requires coverage for up to a 12-month supply of Food
and Drug Administration (FDA) approved, self-administered
hormonal contraceptives (contraceptives) and permits pharmacists
to dispense these contraceptives consistent with existing
protocols and upon a patient's request.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
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
(General Fund (GF)/federal). CHBRP notes utilization of
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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 California Public
Employees' Retirement System 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
reduced total out-of-pocket expenses of $18.7 million.
1)The Department of Health Care Services (DHCS) 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.
2)Minor costs to the California Department of Insurance (CDI
Insurance Fund) and the Department of Managed Health Care
(DMHC Managed Care Fund) to verify plans and insurers comply
with this requirement.
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COMMENTS: According to the author, California has required
insurance coverage for FDA-approved contraception since 1998,
but many hurdles remain. Under current law, health insurance
companies and plans must limit 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. The author cites a University of
California San Francisco study that found that 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 or three month supply. The author states
that there is growing momentum nationwide to provide annual
dispensing.
CHBRP analysis. CHBRP estimates that in 2016, 25.2 million
Californians have state-regulated coverage that would be subject
to this bill. CHBRP estimates that total net annual
expenditures would decrease by $42.8 million or 0.03% for
enrollees with DMHC-regulated plans and CDI-regulated policies.
This represents the anticipated savings in 2017 due to the
avoidance of unintended pregnancies (leading to reduced
delivery, miscarriage, and abortion costs) and the reduced
number of office visits in the first year postmandate. The
decrease in total expenditures is due to a $24 million decrease
in total health insurance premiums paid by employers and
enrollees, along with a decrease in enrollee out-of-pocket
expenditures ($18.7 million), for an overall net decrease of
$42.8 million. Additionally, there is a preponderance of
evidence to indicate that dispensing oral contraceptives in
larger quantities leads to a reduction in unintended pregnancy
and related outcomes. However, fewer studies examine the effect
of the amount of dispensed supply of self-administered hormonal
contraceptives, the primary impact of this bill.
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California Family Planning Program. Family PACT is a
reproductive health program for clinical family planning
services. Family PACT provides comprehensive family planning
services to women and men including all FDA-approved forms of
contraception, emergency contraception, pregnancy testing with
counseling, preconception counseling, male and female
sterilization, limited infertility services, sexually
transmitted infection testing and treatment, cancer screening,
and human immunodeficiency disorder (HIV) screening. Individual
client reproductive health education and counseling is an
ongoing component of all services. Family PACT clients are
female and male residents of California with a family income at
or below 200% of the federal poverty level with no other source
of family planning coverage. Clients are individuals with a
medical necessity for family planning services who do not have
Medi-Cal and do not have access to health insurance. Medi-Cal
clients with an unmet share of cost may also be eligible.
Eligibility determination and enrollment are conducted at the
provider's office with point of service activation of a client
membership card.
Medi-Cal requirements. According to a recently revised All Plan
Letter (APL) issued by the DHCS, effective May 1, 2016, Medi-Cal
managed care plans (MCPs) must pay for up to 13 cycles of oral
contraceptives, up to 12 patches in a 90 day period, and up to
four vaginal rings in a 90 day period if such quantity is
dispensed in an onsite clinic and billed by a qualified family
planning provider, including out-of-plan providers. The APL
also states that under federal law, a primary care case
management system, a health maintenance organization, or a
similar entity shall not restrict the choice of the qualified
person from whom the individual may receive such services under
42 United States Code 1396d(a)(4)(C). Therefore MCP
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beneficiaries must be allowed freedom of choice of family
planning providers, and may receive such services from any
qualified family planning provider, including out-of-plan
providers, without prior authorization. In addition to applying
to MCPs, this bill requires DHCS to issue APLs or similar
instructions to implement this bill.
Other states. Currently, only Oregon and the District of
Columbia have laws in effect that are similar to this bill. At
the time of CHBRP's publication of its analysis, several other
states have considered such legislation, including Alaska, New
York, Rhode Island, Washington, and Wisconsin. Additionally,
some state Medicaid programs and state family planning programs
for low-income residents already require a 12-month supply of
contraceptives to be dispensed at one time, including the Oregon
Contraceptive Care program.
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.
The Association of California Life and Health Insurance
Companies and California Association of Health Plans are opposed
unless amended, seeking amendments to allow a health 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.
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Analysis Prepared by:
Kristene Mapile / HEALTH / (916) 319-2097 FN:
0003758