BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2369
AUTHOR: Valadao
AMENDED: June 14, 2012
HEARING DATE: June 20, 2012
CONSULTANT: Marchand
SUBJECT : Prisoners: pharmacy services.
SUMMARY : Requires the pharmacy services program (pharmacy
program) under the California Department of Corrections and
Rehabilitation (CDCR) to use less expensive medication as
achieved by the statewide prescription drug bulk purchasing
program, as defined, unless an exception is approved or the
prescriber has indicated "dispense as written" on the
prescription.
Existing law:
1.Permits CDCR to maintain and operate a comprehensive pharmacy
program for those facilities under its jurisdiction that is
both cost effective and efficient.
2.Permits the pharmacy program to incorporate a statewide
Pharmacy and Therapeutics Committee responsible, among other
tasks, for developing and managing a department formulary and
conducting regular therapeutic category reviews for medication
listed in the department formulary.
3.Permits the pharmacy program to incorporate 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.
4.Permits the Department of General Services (DGS) to enter into
contracts with manufacturers and suppliers of single-source or
multisource drugs for purposes of a statewide prescription
drug bulk purchasing program. Requires CDCR, the Department of
Mental Health (DMH), and the Department of Developmental
Services (DDS) to participate in this bulk purchasing program.
Permits any other state or local government entity to elect to
participate in the purchasing program.
5.Permits DGS, in consultation with CDCR, DMH, or DDS, to
investigate and implement other options and strategies to
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AB 2369 | Page 2
achieve the greatest savings on prescription drugs with
prescription drug manufacturers and wholesalers.
This bill:
1.Requires the comprehensive pharmacy program, operated by CDCR,
to use less expensive medications as achieved by DGS'
statewide pharmaceutical bulk purchasing program, as
specified, when those medications are available, unless an
exception is reviewed and approved in accordance with an
established nonformulary approval process, or unless the
prescriber has indicated on the prescription "dispense as
written."
FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible state fiscal impact.
PRIOR VOTES :
Assembly Business, Professions and Consumer Protection:6- 0
Assembly Health: 19- 0
Assembly Appropriations: 16- 1
Assembly Floor: 60- 5
COMMENTS :
1.Author's statement. As management of prison health care
services transitions out of the control of the federal
Receiver and back to the jurisdiction of CDCR, it is critical
that fiscal responsibility is maintained while upholding
quality patient care. Utilizing the less expensive
prescriptions on the formulary is an excellent way to maintain
fiscal responsibility. In addition, AB 2369 would strengthen
the physician's ability to make the patient care decisions by
continuing the current nonformulary approval process, as well
as adding a provision to allow the physician to "dispense as
written" when prescribing for their patient.
2.Medical Receivership for CDCR. On June 30, 2005, in a
class-action lawsuit filed four years earlier, the United
States District Court for the Northern District of California
established a Receivership to take control of the delivery of
medical services to all California state prisoners confined by
CDCR. The court order establishing the Receivership provides
that the Receivership, "shall cease as soon as the Court is
satisfied, and so finds in consultation with the Receiver,
that Defendants have the will, capacity, and leadership to
maintain a system of providing constitutionally adequate
medical health care services to class members."
AB 2369 | Page
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The judge in the case issued an order in January 2012 stating
that because of the progress to date, "the end of the
Receivership appears to be in sight, and the Court seeks to
get the parties' and the Receiver's views on when the
Receivership should be terminated and how this case should
progress after the Receivership has ended." The judge ordered
that the parties meet and confer on post-Receivership planning
as soon as possible and filed a joint report on their
meet-and-confer on or before April 30, 2012.
On May 30, 2012, in response to the report filed jointly by the
State and the Receiver, the judge issued a new order outlining
a transition plan for transferring authority from the Receiver
to the state. As part of this gradual transition of authority,
the court ordered the Receiver and the state to identify and
secure appropriate revisions or additions to state law and
regulations, as well as to CDCR's operations manual, that
institutionalize changes made during the Receivership and
eliminate the need for any waivers of state law following the
termination of the Receivership. The Court ordered the parties
to consider the Court's proposal, to file opposition briefs or
statements of non-opposition by June 29, 2012, and to file any
reply briefs no later than July 20, 2012.
3.Double referral. This bill is double referred. Should it
pass out of this committee, it will be referred to the Senate
Committee on Public Safety.
4.Related legislation. SB 1079 (Rubio) would have codified
existing regulations limiting medical services for inmates of
CDCR to only those services which are medically necessary, and
would have excluded treatment for sexual dysfunction or
infertility, gender reassignment surgery, and weight reduction
surgery. SB 1079 passed out of this committee on March 28,
2012 by a vote of 5-0, but failed passage in the Senate Public
Safety Committee on a vote of 3-4.
5.Prior legislation. AB 1628 (Budget Committee), Chapter 729,
Statutes of 2010, the public safety budget trailer bill, among
other provisions, authorized CDCR to operate a pharmacy
program and permitted this pharmacy program to incorporate a
requirement for the use of generic medications, when
available.
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6.Opposition. This bill is opposed by Mental Health America of
California (MHAC), which states that this bill will impair the
recovery of inmates with mental illnesses. MHAC states that
many people will not respond to generic medications and need a
brand name product for which there is no generic equivalent.
MHAC argues that dollars saved in medication costs will be
outweighed by additional mental health and physical health
costs for hospitalizations and physician visits when people
are not on the most effective medication.
SUPPORT AND OPPOSITION :
Support: None received.
Oppose: Mental Health America of California
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