BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 1144
                                                                  Page  1

          Date of Hearing:   May 20, 2009

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                Kevin De Leon, Chair

                     AB 1144 (Price) - As Amended:  May 4, 2009  

          Policy Committee:                              Health Vote:14-2

          Urgency:     No                   State Mandated Local Program:  
          No     Reimbursable:              

           SUMMARY  

          This bill requires health plans and health insurers that provide  
          prescription drug benefits to submit written reports about step  
          therapy each year to the California Department of Managed Health  
          Care (DMHC) and the California Department of Insurance (CDI).  
          Step therapy refers to the practice whereby beneficiaries are  
          required to follow a certain sequence of pain medication to  
          reduce risks or control costs. This bill requires health plans  
          and insurers to report when beneficiaries are required to: 

          1)Use a pain medication for an off-label indication.

          2)Use more than two formulary alternative pain medications prior  
            to a prescription recommended by a provider.

          3)Remain on pain medication for more than seven days prior to  
            being provided medication prescribed by a physician.   

           FISCAL EFFECT  

          One-time fee-supported special fund costs of $100,000, combined,  
          to DMHC and CDI to compile and review report submissions from  
          numerous insurers about the use of step therapy. 

           COMMENTS  

           1)Rationale  . This bill is co-sponsored by For Grace and Healthy  
            African American Families to increase information about the  
            use of step therapy in California. Step therapy is the  
            practice of beginning drug therapy with the most  
            cost-effective and safest drug therapy and progressing to  
            other more costly or risky medications, as necessary.  








                                                                  AB 1144
                                                                  Page  2

            According to the author and sponsors, some patients are  
            required to try up to five medications prior to being  
            prescribed a recommended pain drug. The author indicates these  
            treatment decisions should be left up to provider and patient,  
            not the health plan or insurer. 

           2)Concerns  . Health plans and insurers oppose this bill.  
            Opponents indicate this bill increases administrative costs  
            without providing helpful information and is counterproductive  
            to efforts to increase affordability. 


           Analysis Prepared by  :    Mary Ader / APPR. / (916) 319-2081