BILL ANALYSIS �
AB 2418
Page 1
GOVERNOR'S VETO
AB 2418 (Bonilla and Skinner)
As Amended August 19, 2014
2/3 vote
-----------------------------------------------------------------
|ASSEMBLY: |75-1 |(May 29, 2014) |SENATE: |31-1 |(August 21, |
| | | | | |2014) |
-----------------------------------------------------------------
-----------------------------------------------------------------
|ASSEMBLY: |79-0 |(August 25, | | | |
| | |2014) | | | |
-----------------------------------------------------------------
Original Committee Reference: HEALTH
SUMMARY : Requires health plan contracts and health insurance
policies to allow for the synchronization of prescription
refills, and permit refill of topical ophthalmic medications at
70% of the predicted days of use, effective January 1, 2016.
The Senate amendments remove a provision of this bill that would
have required health plans and insurers to allow enrollees to
opt out of mandatory mail order prescriptions programs.
AS PASSED BY THE ASSEMBLY , this bill was largely the same, but
also included a provision that required health plans and
insurers to allow enrollees to opt out of mandatory mail order
prescription program.
FISCAL EFFECT : 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 California Department of Insurance. One-time
costs of $275,000 and ongoing costs of $40,000 for development
of regulations and enforcement by the Department of Managed
Health Care. Increased health care costs to the California
Public Employees' Retirement System of about $6,000 per year due
to increased prescription drug benefit costs (various funds).
AB 2418
Page 2
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).
COMMENTS : According to the author, this bill is aimed at
improving patient medication adherence and health outcomes
through streamlining the medication refill process.
California Pharmacists Association and California Healthcare
Institute, co-sponsors of this bill, argue that pharmacists play
a key role in helping improve medication adherence and contend
that hundreds of clinical studies show improvement in medication
adherence and benefits to patient health outcomes when
pharmacists work with other members of the care team on
medication therapy.
Health plans, insurers, and pharmacy benefit managers, in
opposing this bill, express concern about the costs and
administrative complexity of the proposed changes. Health plans
and insurers view this bill as micromanaging the prescription
refill process.
GOVERNOR'S VETO MESSAGE :
The bill would require health plans and insurers to
apply a prorated daily cost-sharing rate to the
refills of certain medications if the prescriber or
pharmacist indicates it is in the best interest of the
patient and it is for the purpose of synchronizing
refill dates for the patient's medications. The bill
also allows for early refills of covered eye products.
While I understand the importance of encouraging
people to take their prescribed medications, the bill
lacks explicit patient consent before changes are made
to refills; nor does the bill speak to the supportive
elements that have made synchronization programs
AB 2418
Page 3
anecdotally successful.
Medication adherence is complicated. Solutions to
this problem will likely require a more holistic
approach and collaboration between doctors, patients,
pharmacists and health plans.
Analysis Prepared by : Dharia McGrew / HEALTH / (916) 319-2097
FN: 0005714