BILL ANALYSIS �
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|Hearing Date:April 23, 2012 |Bill No:SB |
| |1301 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Curren D. Price, Jr., Chair
Bill No: SB 1301Author:Hernandez
As Amended:April 16, 2012 Fiscal:Yes
SUBJECT: Prescription drugs: 90-day supply.
SUMMARY: Authorizes a pharmacist to dispense not more than a 90-day
supply of medication pursuant to a valid prescription that specifies
the initial dispensing of a lesser amount followed by periodic refills
of that amount if the patient has completed an initial 30-day supply
of the medication, as specified.
Existing law:
1)Establishes the practice of pharmacy and provides for the licensing
and regulation of pharmacies and pharmacists by the Board of
Pharmacy (Board) within the Department of Consumer Affairs.
2)Specifies certain requirements regarding the dispensing and
furnishing of dangerous drugs and devices, and prohibits a person
from furnishing any dangerous drug or device except upon the
prescription of a physician, dentist, podiatrist, optometrist,
veterinarian or naturopathic doctor, as specified. (BPC � 4059)
3)Prohibits a prescription for any dangerous drug or dangerous device
from being refilled except upon authorization of the prescriber, as
specified. (BPC � 4063)
4)Permits a prescription for a dangerous drug or dangerous device to be
refilled without the prescriber's authorization if the prescriber is
unavailable to authorize the refill and if, in the pharmacist's
professional judgment, failure to refill the prescription might
interrupt the patient's ongoing care and have a significant adverse
effect on the patient's well-being. Specifies that the prescription
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may be filled only after making every reasonable effort to contact
the prescriber. Requires the pharmacist to inform the patient and
the prescriber that the prescription was refilled under this
circumstance. (BPC � 4064)
5)Provides that psychotropic medication or psychotropic drugs are those
medications administered for the purpose of affecting the central
nervous system to treat psychiatric disorders or illnesses. These
medications include, but are not limited to, anxiolytic agents,
antidepressants, mood stabilizers, antipsychotic medications,
anti-Parkinson agents, hypnotics, medications for dementia, and
psychostimulants. (Welfare and Institutions Code � 369.5 (d))
This bill:
1)Authorizes a pharmacist to dispense not more than a 90-day supply of
medication pursuant to a valid prescription that specifies the
initial dispensing of a lesser amount followed by periodic refills
of that amount if the patient has completed an initial 30-day supply
of the medication and all of the following requirements are
satisfied:
a) The total quantity of dosage units dispensed does not exceed
the total quantity of dosage units authorized by the prescriber
on the prescription, including refills.
b) The prescriber has not specified on the prescription that
dispensing the prescription in an initial amount followed by
periodic refills is medically necessary.
c) The pharmacist is exercising his or her professional judgment.
1)Requires a pharmacist dispensing pursuant to these provisions to
notify the prescriber of the change in the quantity dispensed.
2)Specifies that the above provisions do not apply to psychotropic
medication or psychotropic drugs as defined in Welfare and
Institutions Code Section 369.5 (d).
3)Specifies that the above provisions shall not be construed to require
a health care service plan, health insurer, workers' compensation
insurance plan, pharmacy benefits manager, or any other person or
entity, including, but not limited to, a state program or state
employer, to provide coverage for a dangerous drug in a manner
inconsistent with a beneficiary's plan benefit.
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FISCAL EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill is sponsored by California Retailers Association
(Sponsor) in order to permit a pharmacist to dispense up to a 90-day
supply of a drug, other than a controlled substance and psychotropic
medication, as defined in Welfare and Institutions Code Section
369.5 (d), pursuant to a prescription that specifies the initial
dispensing of a lesser amount followed by periodic refills of that
amount if certain requirements are met.
According to the Sponsor and the National Association of Chain Drug
Stores (NACDS), a single chain drug store makes approximately 4.5
million calls a month to get authorization to dispense a
prescription refill in excess of a 30-day supply. Because
physicians are typically busy and unable to take these calls,
consumers end up either having to wait for authorization or they end
up settling for the 30-day supply and leaving before the physician
calls back.
The Sponsor states that not only are these calls burdensome to the
physicians and pharmacists, the patient is ultimately inconvenienced
and will need to return to the pharmacy two additional times and pay
two additional co-payments that he or she would have saved under
this bill.
The 90-day retail prescription option proposed in this measure offers
value to the health care system but, more importantly, to the
consumer, according to the Sponsor, and allows physicians to focus
on more essential patient needs.
2.Background. According to a 2005 Federal Trade Commission study,
private-sector entities that offer prescription drug insurance
coverage, such as employers, labor unions, and managed care
companies, often hire pharmacy benefit managers (PBMs) to manage
these insurance benefits. Many PBMs use mail-order pharmacies to
manage prescription drug costs. Many plan sponsors have encouraged
patients with chronic conditions who require repeated refills to
seek the discounts that 90-day prescriptions and high-volume
mail-order pharmacies can offer.
One way of managing growing medication costs is by using larger
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prescription volumes. An article titled "Ninety-day versus
thirty-day drug dispensing systems" published in American Journal of
Health-System Pharmacy (July 2001) reported a study involving the
U.S. Veterans Affairs San Diego Healthcare System which showed that
dispensing less expensive drugs for 90-days rather than 30-days to
patients with chronic diseases would result in significant cost
savings without compromising safety, despite the possibility of
increased wastage when drugs are discontinued.
3.Practices in Other States. According to the Sponsor, 20 states have
varying statutes that in some way permit 90-day dispensing (Alaska,
Arizona, Colorado, Florida, Hawaii, Idaho, Illinois, Kentucky, Main,
Michigan, Montana, Nebraska, New York, North Carolina, Rhode Island,
South Carolina, South Dakota, Texas, Vermont, and Wyoming). For
example, New York mandates that if a health plan or insurer offers a
90-day supply through a mail-order pharmacy, the enrollee can obtain
the same supply at a retail pharmacy, provided the pharmacy accepts
the same contractual terms and conditions as the mail-order
pharmacy. Indiana has legislation pending on the Governor's desk
that permits 90-days' worth of medication upon the request of the
patient if the patient has completed an initial 30-day supply of the
drug. However, a pharmacist is required to notify the prescriber of
the change in the quantity filled and comply with state and federal
laws and regulations concerning the dispensing limitations
concerning a prescription drug.
4.Arguments in Support. The California Retailers Association , in
sponsoring the bill, writes: "With our aging population, health
care costs will rise dramatically and prescription drug expenditures
will also increase as more people are diagnosed with conditions that
require maintenance drugs. Consumers want and deserve the option of
obtaining a 90-day prescription for their convenience and to allow
them to better adhere to their medical regimen."
Walgreens writes that in California, when a patient presents a
pharmacist a prescription for a medication with refills, the
pharmacist is limited to a 30-day supply. If the patient requests a
combined refill, the pharmacy must contact the prescriber to get
their approval before dispensing the refill. In California,
Walgreens makes 4.5 million of these contacts a month. Walgreens
lists a number of benefits to this bill: Increases convenience for
patients as they would not need to return to the pharmacy multiple
times to refill a prescription; increases access to prescription
medications and pharmacy services for those patients in rural and
inner city areas where travel to a pharmacy is less convenient;
reduces administrative burdens on the physician by negating the need
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for office phone contacts to verify approval for appropriate refill
prescriptions; saves the patient co-payments, where coverage
permits; improves medication adherence, by ensuring fewer trips to
the pharmacy for refill prescriptions; enhances patient choice to
receive their prescription refills at their community pharmacy
(which results in face to face interaction, advice and counseling
from their trusted and chosen pharmacist); emergency planning
personnel recommend having more than a 30-day supply of needed
medications in case of disaster.
California Pharmacists Association (CPhA) believes the bill takes a
relatively small yet meaningful step to safely increase efficiency
in the health care delivery system. CPhA states the bill allows
pharmacists to utilize their professional judgment to provide
medications in amounts that are most convenient to their patients.
This is a safe way to make getting prescriptions filled a more
consumer-friendly process, according to CPhA.
California Healthcare Institute states that the health care system
bears significant costs through patients suffering from chronic
diseases that are not adhering to their prescribed treatment
regimen. By allowing patients to receive up to 90-days worth of a
refill prescription, SB 1301 will make it easier for patients to
adhere to their treatment regimen, live healthier lives and lower
costs throughout the health care system.
5. Recent Amendments. This bill was amended and passed by the Senate
Health Committee on April 11, 2010. According to the Sponsor,
these amendments were intended to address concerns with the bill,
including those raised by the California Psychiatric Association
(CPA) who expressed concern that from a psychiatric physician
standpoint, many psychiatric medications are toxic or lethal, and
that potential is increased significantly when a patient presents
with suicidal ideation. The phrase "psychotropic drug" is a term
referring to psychiatric medicines that alter chemical levels in
the brain which impact mood and behavior. Thus the bill has been
amended to not allow a pharmacist to dispense a 90-day supply of a
psychotropic drug under the provisions of the bill.
In discussing this measure with Committee staff, the Sponsor has
indicated that the amendment requiring a patient to complete an
initial 30-day supply of the medication before a pharmacist could
dispense a 90-day supply was made out of drug waste and disposal
concerns. Allergic or adverse reactions to medication would
typically be apparent within the first month. However, if a three
month supply were initially dispensed, consumers may very well find
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themselves having to dispose of the balance of a prescription that
they cannot use.
NOTE: Double-referral to Health Committee, first. This bill was
heard in Senate Health Committee on April 11 and approved by a 8 to 1
vote.
SUPPORT AND OPPOSITION:
Support :
California Retailers Association (Sponsor)
Aging Services of California
BIOCOM
California Healthcare Institute
California Pharmacists Association
Los Angeles County Board of Supervisors
Mental Health America of California
Walgreens
7 pharmacies
Opposition :
None received as of April 17, 2012
Consultant:G. V. Ayers