BILL ANALYSIS �
AB 399
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Date of Hearing: May 3, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 399 (Bonnie Lowenthal) - As Introduced: February 14, 2011
SUBJECT : Corrections: offender pharmacies.
SUMMARY : Mandates aspects of the California Department of
Corrections and Rehabilitation's (CDCR) pharmacy services
program, such as requiring CDCR's centralized pharmacy
distribution center (CPDC) and institutional pharmacies to be
licensed by the California State Board of Pharmacy (Board),
requires a system of quality control checks for the CPDC, and
requires a program for inspections of all department pharmacies,
as specified. Specifically, this bill :
1)Requires, rather than allows, CDCR's pharmacy services program
to incorporate the following:
a) A statewide pharmacy administration system with direct
authority and responsibility for program administration and
oversight;
b) Medically necessary pharmacy services using
professionally and legally qualified pharmacists,
consistent with the size and the scope of medical services
provided;
c) Written procedures and operational practices pertaining
to the delivery of pharmaceutical services;
d) A multidisciplinary, statewide Pharmacy and Therapeutics
Committee, as specified;
e) A requirement for the use of generic medications, when
available, unless an exception is reviewed and approved in
accordance with an established nonformulary approval
process; and,
f) Use of an enterprise-based pharmacy operating system
that provides management with information on prescription
workloads, medication utilization, prescribing data, and
other key pharmacy information.
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2)Requires the CPDC and institutional pharmacies be licensed as
pharmacies by the Board and requires them to meet all
applicable regulations applying to a pharmacy.
3)Requires, rather than allows, the CPDC to maintain a system of
quality control checks on each process used to package, label,
and distribute medications, as specified.
4)Requires, rather than allows, CDCR to ensure that there is a
program providing for the regular inspection of all department
pharmacies in the state to verify compliance with applicable
laws, rules, regulations, and other standards as may be
appropriate to ensure the health, safety, and welfare of
CDCR's inmate patients.
EXISTING LAW :
1)Authorizes CDCR to maintain and operate a comprehensive
pharmacy services program for those facilities under the
jurisdiction of CDCR that is both cost effective and
efficient, and that may incorporate some or all of the
features specified above.
2)Authorizes CDCR to operate and maintain a CPDC to provide
specified cost advantages, efficiencies, and increased patient
safety.
3)Expresses the intent of the Legislature that the CPDC and
institutional pharmacies be licensed as pharmacies by the
Board meeting all applicable regulations applying to a
pharmacy.
4)States that the CPDC should maintain a system of quality
control checks on each process used to package, label, and
distribute medications.
5)States that CDCR should ensure that there is a program
providing for the regular inspection of all department
pharmacies in the State to verify compliance with applicable
laws, rules, regulations, and other standards as may be
appropriate to ensure the health, safety, and welfare of
CDCR's inmate patients.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
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committee.
COMMENTS :
1)PURPOSE OF THIS BILL . This bill mandates protocols adopted by
the California Prison Health Care Receiver, which the author
and proponents believe is necessary so the federal court will
have assurance there is no backsliding once the state has
responsibility for prison health care again. The author
indicates that the 2010-11 budget trailer bill incorporated
the provisions but they operate more as guidelines for the
development of the centralized program, instead of placing
specific requirements on the features of the system.
Furthermore, the budget bill, and consequently existing law,
did not require the centralized distribution center and
institutional pharmacies to be licensed by the Board.
2)PRISON HEALTH CARE/PHARMACY . California's prison health care
system has been under federal receivership since 2006, after
the court found that inadequate medical care in the state's 33
adult prisons violated the Eighth Amendment of the United
States Constitution forbidding cruel and unusual punishment.
At the direction of the federal Receiver, Maxor National
Pharmacy Services (Maxor) in June 2006 issued a report on
California's prison pharmacy system that found CDCR pharmacy
services were costly, inefficient, and unsafe. Specifically,
pharmacy services suffered from: lack of effective central
oversight and leadership; lack of an operational
infrastructure of policies, processes, technology, and human
resources needed to support an effective program; excessive
costs and inefficiencies in the purchasing processes employed;
and, ineffective systems for contracting, procurement,
distribution, and inventory control. The report also
estimated that prison pharmacies cost California taxpayers
from $46 to $80 million more than equivalent prison systems.
The federal Receiver hired Maxor to oversee an overhaul of the
pharmacy system, which began in January 2007 and lasted three
years.
3)SUPPORT . The American Federation of State, County and
Municipal Employees, AFL-CIO, sponsor of this bill, states
that before a major overhaul that took place between 2007 and
2010, California's prison pharmacy program was not meeting
minimal standards of patient care and was wasting millions of
taxpayer dollars. After the overhaul, a framework established
by the federal Receiver improved pharmacy care and saved the
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state millions of dollars. This bill's requirements are meant
to reinforce the changes made to CDCR from 2007 through 2010.
This bill would ensure the continued high quality and
standards of CDCR and its vital services.
4)PREVIOUS LEGISLATION .
a) AB 1628 (Budget Committee), Chapter 729, Statutes of
2010, is the Public Safety Budget Trailer Bill containing
provisions necessary to implement the 2010-11 Budget,
including authorization for CDCR to maintain a
comprehensive pharmacy services program and to create the
CPDC.
b) AB 2747 (Bonnie Lowenthal) of 2010, which was vetoed,
would have required CDCR to maintain and operate a pharmacy
services program, as specified, and authorizes CDCR to
operate and maintain a CPDC. In his veto message Governor
Schwarzenegger stated, "CDCR is currently under federal
receivership for its health care services. The Receiver
has the authority to conduct the provisions of AB 2747 and
is currently in the process of implementing the CPDC. It
would be premature for me to sign a bill when the
successfulness of the CPDC has yet to be determined."
5)DOUBLE REFERRAL . This bill has been double referred. It
passed the Assembly Committee on Business, Professions &
Consumer Protection with a vote of 9-0 on April 12, 2011.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County and Municipal Employees,
AFL-CIO (sponsor)
California Public Defenders Association
California Society of Health-System Pharmacists
Opposition
None on file.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
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