BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 999|
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UNFINISHED BUSINESS
Bill No: SB 999
Author: Pavley (D), et al.
Amended: 8/19/16
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
SENATE FLOOR: 29-6, 5/23/16
AYES: Allen, Beall, Berryhill, Block, Cannella, De León,
Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill,
Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire,
Mendoza, Mitchell, Monning, Moorlach, Pan, Pavley, Roth, Wolk
NOES: Anderson, Gaines, Morrell, Nielsen, Stone, Vidak
NO VOTE RECORDED: Bates, Fuller, Nguyen, Runner, Wieckowski
ASSEMBLY FLOOR: 68-8, 8/24/16 - See last page for vote
SUBJECT: Health care coverage: contraceptives: annual
supply
SOURCE: California Family Health Council
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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), requires insurance to cover the cost, and incorporates
chaptering amendments for SB 253 (Monning).
Assembly Amendments clarify provisions relating to pharmacist
dispensing and furnishing of SAHC; prohibit a health care
service plan or health care insurer from imposing utilization
controls or other forms of medical management limiting the
supply of FDA-approved SAHC; require the Department of Managed
Health Care to issue all-plan letters or similar instructions to
implement the provisions of this bill; and incorporate
chaptering amendments to SB 253.
ANALYSIS:
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:
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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 a pharmacist to dispense, at a patient's request, up
to a 12-month supply of an FDA-approved, SAHC pursuant to a
valid prescription that specifies an initial quantity followed
by periodic refills.
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)States that nothing in this bill shall be construed to require
a pharmacist to dispense or furnish a drug if it would result
in a violation of specified law.
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
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 or furnished 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.
8)States that a health care service plan or health care insurer
subject to this subdivision, in the absence of clinical
contraindications, shall not impose utilization controls or
other forms of medical management limiting the supply of
FDA-approved SAHC that may be dispensed or furnished by a
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provider or pharmacist, or at a location licensed or otherwise
authorized to dispense drugs or supplies to an amount that is
less than a 12-month supply.
9)Requires the Department of Managed Health Care to issue
all-plan letters or similar instructions to implement the
provisions of this bill.
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, 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
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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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 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
(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
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care services related to unintended pregnancy.
b) Annual premium cost savings to the 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.
2)The Department of Health Care Services notes an impact to
fee-for-service Medi-Cal and Family Planning Access to Care
and Treatment 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.
SUPPORT: (Verified8/24/16)
California Family Health Council (co-source)
NARAL Pro-Choice California (co-source)
Planned Parenthood Affiliates of California (co-source)
ACCESS Women's Health Justice
ACT for Women and Girls
Alameda County Board of Supervisors
American Civil Liberties Union
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American Congress of Obstetricians and Gynecologists, District
IX California
American Medical Women's Association
Asian American Advancing Justice
Asian Law Alliance
Asian and Pacific Islander Obesity Prevention Alliance
Bayer Corporation
Black Women for Wellness
California Academy of Family Physicians
California Academy of Physician Assistants
California Immigrant policy Center
California Latinas for Reproductive Justice
California Medical Association
California Pan-Ethnic Health Network
California Partnership
California Primary Care Association
California Religious Coalition for Reproductive Choice
California Women's Law Center
Cambodian Family Community Center
Central Valley Partnership for Citizenship
City of West Hollywood
Coalition of Human Immigrant Rights of Los Angeles
Community Health Partnership of Santa Clara
Council of Mexican Federations
El Centro Binacional para el Desarrollo Indigena Oaxaqueño
(Fresno, Greenfield)
El Quinto Sol de America
El Proyecto del Barrio, Inc.
Fathers and Families of San Joaquin Valley
Fresno Center of New Americans
Forward Together
Having Our Say
Health Access of California
Inland Empire Immigrant Youth Coalition
Jewish Family Support Services
Kaiser Permanente
Korean Community Center of the East Bay
Korean Resource Center
Latino Coalition for a Healthy California
Local Health Plans of California
Madera Coalition
March of Dimes Foundation
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Mid-City CAN
National Association of Social Workers, California Chapter
Nevada County Citizens for Choice
Nile Sisters Development Initiative
Northeast Valley Health Corporation
PALS for Health
Physicians for Reproductive Health
Planned Parenthood Action Fund of the Pacific Southwest
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Advocates Pasadena and San Gabriel Valley
Planned Parenthood Advocates Santa Barbara, Ventura & San Luis
Obispo Counties
Planned Parenthood Northern California Action Fund
Roots Community Clinic
Santa Clara County Democratic Activists for Women Now
Secular Coalition for California
Services, Immigrant Rights, and Education Network
South Asian Network
South East Asian Resource Action Center
Street Level Health Project
Village Connection, Inc.
Vision y Compromiso
OPPOSITION: (Verified8/24/16)
America's Health Insurance Plans
Association of California Life and Health Insurance Companies
California Association of Health Plans
California Catholic Conference
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
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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.
ASSEMBLY FLOOR: 68-8, 8/24/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bloom, Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chau,
Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Dodd,
Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Hadley, Roger
Hernández, Holden, Irwin, Jones-Sawyer, Kim, Lackey, Levine,
Linder, Lopez, Low, Maienschein, Mayes, McCarty, Medina,
Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Quirk,
Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark
Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams,
Wood, Rendon
NOES: Bigelow, Brough, Grove, Harper, Jones, Mathis, Melendez,
Patterson
NO VOTE RECORDED: Chang, Dahle, Beth Gaines, Gallagher
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
8/25/16 17:34:53
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