BILL NUMBER: AB 2170	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 27, 2010
	AMENDED IN ASSEMBLY  APRIL 13, 2010

INTRODUCED BY   Assembly Member Bonnie Lowenthal

                        FEBRUARY 18, 2010

   An act to add Section 1374.205 to the Health and Safety Code, and
to add Section 10199.485 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2170, as amended, Bonnie Lowenthal. Health care coverage:
prescriptions: formularies.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act's requirements a crime. Existing law provides
for the regulation of health insurers by the Department of Insurance.
Existing law prohibits a group health care service plan or health
insurer, with regard to a group contract, except as specified, from
changing the premium rates or applicable copayments or coinsurances
or deductibles during certain time periods.
   This bill would prohibit a health care service plan or a health
insurer covering prescription drug benefits and using a formulary
from increasing the applicable copayments or deductibles or
coinsurances for prescription drugs for the length of the contract or
policy  ,   including, but not limited to,
during any open enrollment period  .
   Because a willful violation of the bill's requirements with
respect to health care service plans would be a crime, the bill would
impose a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1374.205 is added to the Health and Safety
Code, to read:
   1374.205.  (a) In addition to the prohibitions in subdivision (a)
of Section 1374.20 applicable to group health care service plan
contracts, and notwithstanding subdivision (b) of Section 1374.20, no
health care service plan, with regard to an individual or group
health care service plan contract that covers prescription drug
benefits and uses a formulary, shall increase the applicable
copayments or deductibles for prescription drugs for the length of
the contract  , including, but not limited to, during any
open enrollment period  .
   (b) This section shall not apply to health care service plan
contracts issued through a publicly funded state health care coverage
program, including, but not limited to, the Medi-Cal program and the
Healthy Families Program, or to Medicare supplement contracts.
  SEC. 2.  Section 10199.485 is added to the Insurance Code, to read:

   10199.485.  (a) In addition to the prohibitions in subdivision (a)
of Section 10199.48 applicable to group contracts, and
notwithstanding subdivision (b) of Section 10199.48, no health
insurer, with regard to an individual policy or group contract that
covers prescription drug benefits and uses a formulary shall increase
the applicable copayments or coinsurances or deductibles for
prescription drugs for the length of the policy or contract 
, including, but not limited to, during any open enrollment period
 .
   (b) This section shall not apply to an individual policy or group
contract issued through a publicly funded state health care coverage
program, including, but not limited to, the Medi-Cal program and the
Healthy Families Program, or to Medicare supplement contracts.
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.