BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 2418|
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THIRD READING
Bill No: AB 2418
Author: Bonilla (D), et al.
Amended: 8/19/14 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 7-0, 6/25/14
AYES: Hernandez, Beall, De Le�n, DeSaulnier, Evans, Monning,
Nielsen
NO VOTE RECORDED: Morrell, Wolk
SENATE APPROPRIATIONS COMMITTEE : 6-0, 8/14/14
AYES: De Le�n, Gaines, Hill, Lara, Padilla, Steinberg
NO VOTE RECORDED: Walters
ASSEMBLY FLOOR : 75-1, 5/29/14 - See last page for vote
SUBJECT : Health care coverage: prescription drugs: refills
SOURCE : California Healthcare Institute
California Pharmacists Association
DIGEST : This bill requires a health care service plan
contract or health insurance policy issued, amended, or renewed
on or after January 1, 2016, that provides coverage for
prescription drug benefits to permit and apply a prorated daily
cost-sharing rate to refills of prescriptions that are dispensed
by a participating pharmacy for less than the standard refill
amount if the prescriber or pharmacist indicates that the refill
is in the best interest of the enrollee or insured and is for
the purpose of synchronizing the refill dates of the enrollee's
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or insured's medications, provided that certain requirements are
satisfied. This bill also requires a health care service plan
contract or health insurance policy issued, amended, or renewed
on or after January 1, 2016, that provides coverage for
prescription drug benefits to allow for the early refill of
covered topical ophthalmic products at 70% of the predicted days
of use.
ANALYSIS :
Existing law:
1. Requires health care service plans to be regulated by the
Department of Managed Health Care (DMHC) and health insurers
to be regulated by the Department of Insurance (CDI).
2. Requires health care plans and health insurers that cover
prescription drug benefits to provide notice in the evidence
of coverage and disclosure form to enrollees/insureds
regarding whether the plan uses a formulary.
3. Limits, for an individual or group health care service plan
contract or health insurance policy issued, amended, or
renewed on or after January 1, 2015, that provides coverage
for prescribed, orally administered anticancer medications
used to kill or slow the growth of cancerous cells, the total
amount of copayments and coinsurance an enrollee or insured
is required to pay for orally administered anticancer
medications to $200 for an individual prescription of up to a
30-day supply.
4. Mandates the ten federally required Essential Health Benefits
(EHBs) including prescription drug coverage and establishes
Kaiser Small Group health plan as California's EHB benchmark
plan for non-grandfathered individual and small group health
plan contracts and insurance policies.
This bill:
1. Requires a health plan contract or insurance policy issued,
amended, or renewed on or after January 1, 2016, that
provides coverage for prescription drug benefits to permit
and apply a prorated daily cost-sharing rate to the refills
of prescriptions that are dispensed by a participating
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pharmacy for less than the standard refill amount if the
prescriber or pharmacist indicates that the refill for less
than the standard amount is in the best interest of the
enrollee or insured and is for the purpose of synchronizing
the refill dates of the enrollee's or insured's medications
and all of the following apply:
A. The prescription drugs being synchronized are covered
and authorized by the health plan contract or health
insurance policy;
B. The prescription drugs being refilled for less than
the standard amount are not subject to quantity limits
or other utilization management controls that are
inconsistent with the synchronization plan, including,
but not limited to, controlled substance prescribing and
dispensing guidelines intended to prevent misuse or
abuse;
C. The prescription drugs being synchronized are
dispensed by a single participating pharmacy;
D. The patient has completed at least 90 consecutive
days on the prescription drugs being synchronized;
E. The prescription drugs being refilled for less than
the standard amount are of a formulation that can be
effectively split over the required short fill period to
achieve synchronization; and
F. The prescriber has not done either of the following
with respect to the prescription drugs being refilled
for less than the standard amount:
(1) Indicated, either orally or in his/her own
handwriting, "No change to quantity," or words of
similar meaning; or
(2) Checked a box on the prescription marked "No
change to quantity," and personally initialed the
box or checkmark.
2. Exempts, from #1) through #4) above, a drug that is not
available at a participating community pharmacy due to any of
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the following:
A. An industry shortage listed on the Current Drug
Shortages Index maintained by the federal Food and Drug
Administration (FDA);
B. A manufacturer's instructions or restrictions;
C. Any risk evaluation and management strategy approved
by the FDA; or
D. A special shortage affecting the plan's network of
participating pharmacies.
3. Requires a health plan contract or health insurance policy
issued, amended, or renewed on or after January 1, 2016, that
provides coverage for prescription drug benefits to allow for
early refills of covered topical ophthalmic products at 70%
of the predicted days of use.
4. Prohibits anything in this bill from being construed to
establish a new mandated benefit or to prevent the
application of deductible or copayment provisions in a plan
contract.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
One-time costs of $80,000 and ongoing costs of $70,000 per year
for review of insurance plan filings and enforcement by the
CDI (Insurance Fund).
One-time costs of $275,000 and ongoing costs of $40,000 for
development of regulations and enforcement by the DMHC
(Managed Care Fund).
Increased health care costs to CalPERS of about $6,000 per year
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due to increased prescription drug benefit costs (various
funds) costs.
Increased health care costs to the Medi-Cal program, due to
increased prescription drug costs to Medi-Cal managed care
plans of about $155,000 per year (General Fund and federal
funds).
SUPPORT : (Verified 8/19/14)
California Healthcare Institute (co-source)
California Pharmacists Association (co-source)
AFSCME, AFL-CIO
ALS Association
American Cancer Society
Association of Northern CA Oncologists
BayBio
BioCom
Biotechnology Industry Organization (BIO)
California Association of Area Agencies on Aging
California Chronic Care Coalition
California Grocers Association
California Health Collaborative
California Hepatitis C Task Force
California Optometric Association
California Pan-Ethnic Health Network
California Senior Advocates League
California Senior Legislature
California Urological Association
CAPG - The Voice of Accountable Physician Groups
Central Drug Store
Congress of California Seniors
Contra Costa County Public Guardian/Conservators Department
Hemophilia Council of California
Herndon Pharmacy
Huntington's Disease Society of America
International Foundation for Autoimmune Arthritis
La Clinica de La Raza, Inc.
Latina Breast Cancer Agency
Latinas Contra Cancer
Mental Health America of California
Mental Health Systems
National Association for the Advancement of Colored People
(NAACP)
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National Association of Chain Drug Stores
National Multiple Sclerosis Society
Patterson Family Pharmacy
Pharmaceutical Research and Manufacturers of American (PhRMA)
Rehabilitation Services of Northern California (RSNC)
Rite Aid
Sacramento Latino Medical Association
Safeway
SEIU - UHW (United Healthcare Workers West)
Spondylitis Association of America
The Wall Las Memorias
United Food and Commercial Workers Union
United Nurses Associations of California/Union of Health Care
Professionals
Walgreens
OPPOSITION : (Verified 8/19/14)
Aetna
America's Health Insurance Plans
Association of California Life and Health Insurance Companies
Blue Shield
California Association of Health Plans
CSAC Excess Insurance Authority
CVS Caremark
Department of Managed Health Care
Express Scripts
Pharmaceutical Care Management Association
United Health Group
ARGUMENTS IN SUPPORT : The author's office states that that
poor medication adherence is a major barrier to achieving better
patient health outcomes and that this bill streamlines the
medication refill process by making it more convenient for
patients to pick up all their medications on one trip to the
pharmacy and allows patients who run out of eye drops to obtain
an early refill.
ARGUMENTS IN OPPOSITION : The California Association of Health
Plans (CAHP) opposes the refill synchronization process for
prescription drugs because it is confusing and logistically
impractical. CAHP states that requiring plans to accept a
pro-rated daily cost-share for early refills is impractical when
claims systems are not set up to accept partial service fees.
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CAHP claims that plans will have to manually calculate a daily
rate for each synchronization and it would complicate the
ability to track member payments toward their deductible.
ASSEMBLY FLOOR : 75-1, 5/29/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Beth Gaines, Garcia, Gomez, Gonzalez, Gordon, Gorell, Gray,
Grove, Hagman, Roger Hern�ndez, Holden, Jones, Jones-Sawyer,
Levine, Linder, Logue, Lowenthal, Maienschein, Mansoor,
Medina, Melendez, Mullin, Muratsuchi, Nazarian, Nestande,
Olsen, Pan, Patterson, Perea, John A. P�rez, V. Manuel P�rez,
Quirk, Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas,
Skinner, Stone, Ting, Wagner, Waldron, Weber, Wieckowski,
Wilk, Williams, Yamada, Atkins
NOES: Gatto
NO VOTE RECORDED: Donnelly, Hall, Harkey, Vacancy
JL:d 8/19/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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