SB 1052,
as amended, Torres. California Health Benefit Exchange: annualbegin delete report.end deletebegin insert report: qualified health plan formularies.end insert
Existing law establishes the California Health Benefit Exchange within state government, specifies the powers and duties of the board governing the Exchange, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers. Existing law requires the board to undertake activities necessary to market and publicize the availability of health care coverage and federal subsidies through the Exchange and to undertake outreach and enrollment activities that seek to assist with enrolling in the Exchange in the least burdensome manner. Existing law also requires the board of the Exchange to annually prepare a written report on the implementation and performance of the Exchange functions during the preceding fiscal year, as specified, and requires that this report be submitted to the Legislature and the Governor and be made available to the public on the Internet Web site of the Exchange.
This bill,begin delete in addition,end delete wouldbegin insert alsoend insert require the report to include the total number of uninsured Californians as a percentage of the state population and an independent evaluation of the marketing and outreach and enrollment activities undertaken by the Exchange.
Existing law requires the board of the Exchange to determine the minimum requirements a carrier must meet to be considered for participation in the Exchange and the standards and criteria for selecting qualified health plans to be offered through the Exchange that are in the best interests of qualified individuals and qualified small employers.
end insertbegin insertThis bill would prohibit the Exchange from offering a qualified health plan unless the carrier offering the plan posts the formulary for the plan on the Internet Web site of the carrier, updates that posting within 24 hours after making any changes to the formulary, uses a standard template to display the formulary for all qualified health plans offered by the carrier, and includes in any published formulary the prior authorization or step edit requirements for, and the range of coinsurance cost of, each drug included on the formulary. The bill would require the board of the Exchange to ensure that its Internet Web site provides a direct link to the formulary posted by a carrier before the plan is offered through the Exchange. The bill would also require the board to create a search tool on its Internet Web site that allows potential enrollees to search for qualified health plans by a particular drug and by a particular therapeutic condition.
end insertVote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 100503 of the Government Code, as
2amended by Section 4 of Chapter 5 of thebegin delete 1stend deletebegin insert Firstend insert Extraordinary
3Session of the Statutes of 2013, is amended to read:
In addition to meeting the minimum requirements of
5Section 1311 of the federal act, the board shall do all of the
6following:
7(a) Determine the criteria and process for eligibility, enrollment,
8and disenrollment of enrollees and potential enrollees in the
9Exchange and coordinate that process with the state and local
10government entities administering other health care coverage
11programs, including the State Department of Health Care Services,
12the Managed Risk Medical Insurance Board, and California
13counties, in order to ensure consistent eligibility and enrollment
14processes and seamless transitions between coverage.
P3 1(b) Develop processes to
coordinate with the county entities
2that administer eligibility for the Medi-Cal program and the entity
3that determines eligibility for the Healthy Families Program,
4including, but not limited to, processes for case transfer, referral,
5and enrollment in the Exchange of individuals applying for
6assistance to those entities, if allowed or required by federal law.
7(c) Determine the minimum requirements a carrier must meet
8to be considered for participation in the Exchange, and the
9standards and criteria for selecting qualified health plans to be
10offered through the Exchange that are in the best interests of
11qualified individuals and qualified small employers. The board
12shall consistently and uniformly apply these requirements,
13standards, and criteria to all carriers. In the course of selectively
14contracting for health care coverage offered to
qualified individuals
15and qualified small employers through the Exchange, the board
16shall seek to contract with carriers so as to provide health care
17coverage choices that offer the optimal combination of choice,
18value, quality, and service.
19(d) Provide, in each region of the state, a choice of qualified
20health plans at each of the five levels of coverage contained in
21subsections (d) and (e) of Section 1302 of the federal act.
22(e) Require, as a condition of participation in the Exchange,
23carriers to fairly and affirmatively offer, market, and sell in the
24Exchange at least one product within each of the five levels of
25coverage contained in subsections (d) and (e) of Section 1302 of
26the federal act. The board may require carriers to offer additional
27products within each of
those five levels of coverage. This
28subdivision shall not apply to a carrier that solely offers
29supplemental coverage in the Exchange under paragraph (10) of
30subdivision (a) of Section 100504.
31(f) (1) Except as otherwise provided in this section and Section
32100504.5, require, as a condition of participation in the Exchange,
33carriers that sell any products outside the Exchange to do both of
34the following:
35(A) Fairly and affirmatively offer, market, and sell all products
36made available to individuals in the Exchange to individuals
37purchasing coverage outside the Exchange.
38(B) Fairly and affirmatively offer, market, and sell all products
39made available to small employers in the Exchange to small
40employers
purchasing coverage outside the Exchange.
P4 1(2) For purposes of this subdivision, “product” does not include
2contracts entered into pursuant to Part 6.2 (commencing with
3Section 12693) of Division 2 of the Insurance Code between the
4Managed Risk Medical Insurance Board and carriers for enrolled
5
Healthy Families beneficiaries or contracts entered into pursuant
6to Chapter 7 (commencing with Section 14000) of, or Chapter 8
7(commencing with Section 14200) of, Part 3 of Division 9 of the
8Welfare and Institutions Code between the State Department of
9Health Care Services and carriers for enrolled Medi-Cal
10beneficiaries. “Product” also does not include a bridge plan product
11offered pursuant to Section 100504.5.
12(3) Except as required by Section 1301(a)(1)(C)(ii) of the federal
13act, a carrier offering a bridge plan product in the Exchange may
14limit the products it offers in the Exchange solely to a bridge plan
15product contract.
16(g) Determine when an enrollee’s coverage commences and the
17extent and scope of coverage.
18(h) Provide for the processing of applications and the enrollment
19and disenrollment of enrollees.
20(i) Determine and approve cost-sharing provisions for qualified
21health plans.
22(j) Establish uniform billing and payment policies for qualified
23health plans offered in the Exchange to ensure consistent
24enrollment and disenrollment activities for individuals enrolled in
25the Exchange.
26(k) Undertake activities necessary to market and publicize the
27availability of health care coverage and federal subsidies through
28the Exchange. The board shall also undertake outreach and
29enrollment activities that seek to assist enrollees and potential
30enrollees with enrolling and reenrolling in the Exchange in the
31least
burdensome manner, including populations that may
32experience barriers to enrollment, such as the disabled and those
33with limited English language proficiency.
34(l) Select and set performance standards and compensation for
35navigators selected under subdivision (l) of Section 100502.
36(m) Employ necessary staff.
37(1) The board shall hire a chief fiscal officer, a chief operations
38officer, a director for the SHOP Exchange, a director of Health
39Plan Contracting, a chief technology and information officer, a
P5 1general counsel, and other key executive positions, as determined
2by the board, who shall be exempt from civil service.
3(2) (A) The board shall set
the salaries for the exempt positions
4described in paragraph (1) and subdivision (i) of Section 100500
5in amounts that are reasonably necessary to attract and retain
6individuals of superior qualifications. The salaries shall be
7published by the board in the board’s annual budget. The board’s
8
annual budget shall be posted on the Internet Web site of the
9Exchange. To determine the compensation for these positions, the
10board shall cause to be conducted, through the use of independent
11outside advisors, salary surveys of both of the following:
12(i) Other state and federal health insurance exchanges that are
13most comparable to the Exchange.
14(ii) Other relevant labor pools.
15(B) The salaries established by the board under subparagraph
16(A) shall not exceed the highest comparable salary for a position
17of that type, as determined by the surveys conducted pursuant to
18subparagraph (A).
19(C) The Department of Human Resources shall review the
20methodology
used in the surveys conducted pursuant to
21subparagraph (A).
22(3) The positions described in paragraph (1) and subdivision (i)
23of Section 100500 shall not be subject to otherwise applicable
24provisions of the Government Code or the Public Contract Code
25and, for those purposes, the Exchange shall not be considered a
26state agency or public entity.
27(n) Assess a charge on the qualified health plans offered by
28carriers that is reasonable and necessary to support the
29development, operations, and prudent cash management of the
30Exchange. This charge shall not affect the requirement under
31Section 1301 of the federal act that carriers charge the same
32premium rate for each qualified health plan whether offered inside
33or outside the Exchange.
34(o) Authorize expenditures, as necessary, from the California
35Health Trust Fund to pay program expenses to administer the
36Exchange.
37(p) Keep an accurate accounting of all activities, receipts, and
38expenditures, and annually submit to the United States Secretary
39of Health and Human Services a report concerning that accounting.
P6 1Commencing January 1, 2016, the board shall conduct an annual
2audit.
3(q) (1) (A) Annually prepare a written report on the
4implementation and performance of the Exchange functions during
5the preceding fiscal year, including, at a minimum, all of the
6following:
7(i) The manner in which funds were expended and the progress
8toward, and the
achievement of, the requirements of this title.
9(ii) Data provided by health care service plans and health
10insurers offering bridge plan products regarding the extent of health
11care provider and health facility overlap in their Medi-Cal networks
12as compared to the health care provider and health facility networks
13contracting with the plan or insurer in their bridge plan contracts.
14(iii) The total number of uninsured Californians as a percentage
15of the state population.
16(iv) An evaluation of the effectiveness of the activities
17undertaken pursuant to subdivision (k). This evaluation shall be
18conducted by an independent entity selected by the board.
19(B) The report
required by this paragraph shall be transmitted
20to the Legislature and the Governor and shall be made available
21to the public on the Internet Web site of the Exchange. A report
22made to the Legislature pursuant to this paragraph shall be
23submitted pursuant to Section 9795.
24(2) The Exchange shall prepare, or contract for the preparation
25of, an evaluation of the bridge plan program using the first three
26years of experience with the program. The evaluation shall be
27provided to the health policy and fiscal committees of the
28Legislature in the fourth year following federal approval of the
29bridge plan option. The evaluation shall include, but not be limited
30to, all of the following:
31(A) The number of individuals eligible to participate in the
32bridge plan program each year by category of
eligibility.
33(B) The number of eligible individuals who elect a bridge plan
34option each year by category of eligibility.
35(C) The average length of time, by region and statewide, that
36individuals remain in the bridge plan option each year by category
37of eligibility.
38(D) The regions of the state with a bridge plan option, and the
39carriers in each region that offer a bridge plan, by year.
P7 1(E) The premium difference each year, by region, between the
2bridge plan and the first and second lowest cost plan for individuals
3in the Exchange who are not eligible for the bridge plan.
4(F) The effect of the bridge
plan on the premium subsidy amount
5for bridge plan eligible individuals each year by each region.
6(G) Based on a survey of individuals enrolled in the bridge plan:
7(i) Whether individuals enrolling in the bridge plan product are
8able to keep their existing health care providers.
9(ii) Whether individuals would want to retain their bridge plan
10product, buy a different Exchange product, or decline to purchase
11health insurance if there was no bridge plan product available. The
12Exchange may include questions designed to elicit the information
13in this subparagraph as part of an existing survey of individuals
14receiving coverage in the Exchange.
15(3) In addition to the
evaluation required by paragraph (2), the
16Exchange shall post the items in subparagraphs (A) to (F),
17inclusive, on its Internet Web site each year.
18(4) In addition to the report described in paragraph (1), the board
19shall be responsive to requests for additional information from the
20Legislature, including providing testimony and commenting on
21proposed state legislation or policy issues. The Legislature finds
22and declares that activities including, but not limited to, responding
23to legislative or executive inquiries, tracking and commenting on
24legislation and regulatory activities, and preparing reports on the
25implementation of this title and the performance of the Exchange,
26are necessary state requirements and are distinct from the
27promotion of legislative or regulatory modifications referred to in
28subdivision (d) of Section 100520.
29(r) Maintain enrollment and expenditures to ensure that
30expenditures do not exceed the amount of revenue in the fund, and
31if sufficient revenue is not available to pay estimated expenditures,
32institute appropriate measures to ensure fiscal solvency.
33(s) Exercise all powers reasonably necessary to carry out and
34comply with the duties, responsibilities, and requirements of this
35act and the federal act.
36(t) Consult with stakeholders relevant to carrying out the
37activities under this title, including, but not limited to, all of the
38following:
39(1) Health care consumers who are enrolled in health plans.
P8 1(2) Individuals and entities with experience in facilitating
2enrollment in health plans.
3(3) Representatives of small businesses and self-employed
4individuals.
5(4) The State Medi-Cal Director.
6(5) Advocates for enrolling hard-to-reach populations.
7(u) Facilitate the purchase of qualified health plans in the
8Exchange by qualified individuals and qualified small employers
9no later than January 1, 2014.
10(v) Report, or contract with an independent entity to report, to
11the Legislature by December 1, 2018, on whether to adopt the
12option in Section 1312(c)(3) of the federal act to merge the
13individual
and small employer markets. In its report, the board
14shall provide information, based on at least two years of data from
15the Exchange, on the potential impact on rates paid by individuals
16and by small employers in a merged individual and small employer
17market, as compared to the rates paid by individuals and small
18employers if a separate individual and small employer market is
19maintained. A report made pursuant to this subdivision shall be
20submitted pursuant to Section 9795.
21(w) With respect to the SHOP Program, collect premiums and
22administer all other necessary and related tasks, including, but not
23limited to, enrollment and plan payment, in order to make the
24offering of employee plan choice as simple as possible for qualified
25small employers.
26(x) Require carriers
participating in the Exchange to immediately
27notify the Exchange, under the terms and conditions established
28by the board when an individual is or will be enrolled in or
29disenrolled from any qualified health plan offered by the carrier.
30(y) Ensure that the Exchange provides oral interpretation
31services in any language for individuals seeking coverage through
32the Exchange and makes available a toll-free telephone number
33for the hearing and speech impaired. The board shall ensure that
34written information made available by the Exchange is presented
35in a plainly worded, easily understandable format and made
36available in prevalent languages.
37(z) This section shall become inoperative on the October 1 that
38is five years after the date that federal approval of the bridge plan
39option occurs,
and, as of the second January 1 thereafter, is
40repealed, unless a later enacted statute that is enacted before that
P9 1date deletes or extends the dates on which it becomes inoperative
2and is repealed.
Section 100503 of the Government Code, as added by
4Section 5 of Chapter 5 of thebegin delete 1stend deletebegin insert Firstend insert Extraordinary Session of
5the Statutes of 2013, is amended to read:
In addition to meeting the minimum requirements of
7Section 1311 of the federal act, the board shall do all of the
8following:
9(a) Determine the criteria and process for eligibility, enrollment,
10and disenrollment of enrollees and potential enrollees in the
11Exchange and coordinate that process with the state and local
12government entities administering other health care coverage
13programs, including the State Department of Health Care Services,
14the Managed Risk Medical Insurance Board, and California
15counties, in order to ensure consistent eligibility and enrollment
16processes and seamless transitions between coverage.
17(b) Develop processes to
coordinate with the county entities
18that administer eligibility for the Medi-Cal program and the entity
19that determines eligibility for the Healthy Families Program,
20including, but not limited to, processes for case transfer, referral,
21and enrollment in the Exchange of individuals applying for
22assistance to those entities, if allowed or required by federal law.
23(c) Determine the minimum requirements a carrier must meet
24to be considered for participation in the Exchange, and the
25standards and criteria for selecting qualified health plans to be
26offered through the Exchange that are in the best interests of
27qualified individuals and qualified small employers. The board
28shall consistently and uniformly apply these requirements,
29standards, and criteria to all carriers. In the course of selectively
30contracting for health care coverage offered to
qualified individuals
31and qualified small employers through the Exchange, the board
32shall seek to contract with carriers so as to provide health care
33coverage choices that offer the optimal combination of choice,
34value, quality, and service.
35(d) Provide, in each region of the state, a choice of qualified
36health plans at each of the five levels of coverage contained in
37subsections (d) and (e) of Section 1302 of the federal act.
38(e) Require, as a condition of participation in the Exchange,
39carriers to fairly and affirmatively offer, market, and sell in the
40Exchange at least one product within each of the five levels of
P10 1coverage contained in subsections (d) and (e) of Section 1302 of
2the federal act. The board may require carriers to offer additional
3products within each of those five
levels of coverage. This
4subdivision shall not apply to a carrier that solely offers
5supplemental coverage in the Exchange under paragraph (10) of
6subdivision (a) of Section 100504.
7(f) (1) Require, as a condition of participation in the Exchange,
8carriers that sell any products outside the Exchange to do both of
9the following:
10(A) Fairly and affirmatively offer, market, and sell all products
11made available to individuals in the Exchange to individuals
12purchasing coverage outside the Exchange.
13(B) Fairly and affirmatively offer, market, and sell all products
14made available to small employers in the Exchange to small
15employers purchasing coverage outside the Exchange.
16(2) For purposes of this subdivision, “product” does not include
17contracts entered into pursuant to Part 6.2 (commencing with
18Section 12693) of Division 2 of the Insurance Code between the
19Managed Risk Medical Insurance Board and carriers for enrolled
20Healthy Families beneficiaries or contracts entered into pursuant
21to Chapter 7 (commencing with Section 14000) of, or Chapter 8
22(commencing with Section 14200) of, Part 3 of Division 9 of the
23Welfare and Institutions Code between the State Department of
24Health Care Services and carriers for enrolled Medi-Cal
25beneficiaries.
26(g) Determine when an enrollee’s coverage commences and the
27extent and scope of coverage.
28(h) Provide for the processing of applications and the
enrollment
29and disenrollment of enrollees.
30(i) Determine and approve cost-sharing provisions for qualified
31health plans.
32(j) Establish uniform billing and payment policies for qualified
33health plans offered in the Exchange to ensure consistent
34enrollment and disenrollment activities for individuals enrolled in
35the Exchange.
36(k) Undertake activities necessary to market and publicize the
37availability of health care coverage and federal subsidies through
38the Exchange. The board shall also undertake outreach and
39enrollment activities that seek to assist enrollees and potential
40enrollees with enrolling and reenrolling in the Exchange in the
P11 1least burdensome manner, including populations that may
2experience barriers to
enrollment, such as the disabled and those
3with limited English language proficiency.
4(l) Select and set performance standards and compensation for
5navigators selected under subdivision (l) of Section 100502.
6(m) Employ necessary staff.
7(1) The board shall hire a chief fiscal officer, a chief operations
8officer, a director for the SHOP Exchange, a director of Health
9
Plan Contracting, a chief technology and information officer, a
10general counsel, and other key executive positions, as determined
11by the board, who shall be exempt from civil service.
12(2) (A) The board shall set the salaries for the exempt positions
13described in paragraph (1) and subdivision (i) of Section 100500
14in amounts that are reasonably necessary to attract and retain
15individuals of superior qualifications. The salaries shall be
16published by the board in the board’s annual budget. The board’s
17annual budget shall be posted on the Internet Web site of the
18Exchange. To determine the compensation for these positions, the
19board shall cause to be conducted, through the use of independent
20outside advisors, salary surveys of both of the following:
21(i) Other state and federal health insurance exchanges that are
22most comparable to the Exchange.
23(ii) Other relevant labor pools.
24(B) The salaries established by the board under subparagraph
25(A) shall not exceed the highest comparable salary for a position
26of that type, as determined by the surveys conducted pursuant to
27subparagraph (A).
28(C) The Department of Human Resources shall review the
29methodology used in the surveys conducted pursuant to
30subparagraph (A).
31(3) The positions described in paragraph (1) and subdivision (i)
32of Section 100500 shall not be subject to otherwise applicable
33provisions of the Government Code or the Public Contract
Code
34and, for those purposes, the Exchange shall not be considered a
35state agency or public entity.
36(n) Assess a charge on the qualified health plans offered by
37carriers that is reasonable and necessary to support the
38development, operations, and prudent cash management of the
39Exchange. This charge shall not affect the requirement under
40Section 1301 of the federal act that carriers charge the same
P12 1premium rate for each qualified health plan whether offered inside
2or outside the Exchange.
3(o) Authorize expenditures, as necessary, from the California
4Health Trust Fund to pay program expenses to administer the
5Exchange.
6(p) Keep an accurate accounting of all activities, receipts, and
7expenditures, and annually
submit to the United States Secretary
8of Health and Human Services a report concerning that accounting.
9Commencing January 1, 2016, the board shall conduct an annual
10audit.
11(q) (1) (A) Annually prepare a written report on the
12implementation and performance of the Exchange functions during
13the preceding fiscal year, including, at a minimum, all of the
14following:
15(i) The manner in which funds were expended and the progress
16toward, and the achievement of, the requirements of this title.
17(ii) The total number of uninsured Californians as a percentage
18of the state population.
19(iii) An evaluation of the effectiveness of
the activities
20undertaken pursuant to subdivision (k). This evaluation shall be
21conducted by an independent entity selected by the board.
22(B) The report required by this paragraph shall be transmitted
23to the Legislature and the Governor and shall be made available
24to the public on the Internet Web site of the Exchange. A report
25made to the Legislature pursuant to this paragraph
shall be
26submitted pursuant to Section 9795.
27(2) In addition to the report described in paragraph (1), the board
28shall be responsive to requests for additional information from the
29Legislature, including providing testimony and commenting on
30proposed state legislation or policy issues. The Legislature finds
31and declares that activities including, but not limited to, responding
32to legislative or executive inquiries, tracking and commenting on
33legislation and regulatory activities, and preparing reports on the
34implementation of this title and the performance of the Exchange,
35are necessary state requirements and are distinct from the
36promotion of legislative or regulatory modifications referred to in
37subdivision (d) of Section 100520.
38(r) Maintain enrollment and expenditures to
ensure that
39expenditures do not exceed the amount of revenue in the fund, and
P13 1if sufficient revenue is not available to pay estimated expenditures,
2institute appropriate measures to ensure fiscal solvency.
3(s) Exercise all powers reasonably necessary to carry out and
4comply with the duties, responsibilities, and requirements of this
5act and the federal act.
6(t) Consult with stakeholders relevant to carrying out the
7activities under this title, including, but not limited to, all of the
8following:
9(1) Health care consumers who are enrolled in health plans.
10(2) Individuals and entities with experience in facilitating
11enrollment in health plans.
12(3) Representatives of small businesses and self-employed
13individuals.
14(4) The State Medi-Cal Director.
15(5) Advocates for enrolling hard-to-reach populations.
16(u) Facilitate the purchase of qualified health plans in the
17Exchange by qualified individuals and qualified small employers
18no later than January 1, 2014.
19(v) Report, or contract with an independent entity to report, to
20the Legislature by December 1, 2018, on whether to adopt the
21option in Section 1312(c)(3) of the federal act to merge the
22individual and small employer markets. In its report, the board
23shall provide information, based on at
least two years of data from
24the Exchange, on the potential impact on rates paid by individuals
25and by small employers in a merged individual and small employer
26market, as compared to the rates paid by individuals and small
27employers if a separate individual and small employer market is
28maintained. A report made pursuant to this subdivision shall be
29submitted pursuant to Section 9795.
30(w) With respect to the SHOP Program, collect premiums and
31administer all other necessary and related tasks, including, but not
32limited to, enrollment and plan payment, in order to make the
33offering of employee plan choice as simple as possible for qualified
34small employers.
35(x) Require carriers participating in the Exchange to immediately
36notify the Exchange, under the terms and conditions
established
37by the board when an individual is or will be enrolled in or
38disenrolled from any qualified health plan offered by the carrier.
39(y) Ensure that the Exchange provides oral interpretation
40services in any language for individuals seeking coverage through
P14 1the Exchange and makes available a toll-free telephone number
2for the hearing and speech impaired. The board shall ensure that
3written information made available by the Exchange is presented
4in a plainly worded, easily understandable format and made
5available in prevalent languages.
6(z) This section shall become operative only if Section 4 of the
7act that added this section becomes inoperative pursuant to
8subdivision (z) of that Section 4.
begin insertSection 100503.1 is added to the end insertbegin insertGovernment Codeend insertbegin insert,
10to read:end insert
(a) A qualified health plan shall not be offered
12through the Exchange unless the carrier offering the plan does all
13of the following:
14(1) Posts the formulary for the qualified health plan on the
15Internet Web site of the carrier in a manner that is accessible and
16searchable by potential enrollees, enrollees, and providers.
17(2) Updates the formulary posted pursuant to paragraph (1)
18with any change to that formulary within 24 hours after making
19the change.
20(3) Uses a standard template to display the formulary for all
21qualified health plans offered by the carrier. This template shall
22do both of the following:
23(A) Use the United States Pharmacopeia classification system.
24(B) Organize drugs by therapeutic class, listing drugs
25alphabetically.
26(4) Includes both of the following on any published formulary
27for the qualified health plan, including, but not limited to, the
28formulary posted pursuant to paragraph (1):
29(A) Any prior authorization or step edit requirements for each
30specific drug included on the formulary.
31(B) The range of coinsurance cost to a potential enrollee of
32each specific drug included on the formulary, as follows:
33(i) Under $100 - $.
34(ii) $100-$250 - $$.
35(iii) $251-$500 - $$$.
36(iv) Over $500 - $$$$.
37(b) The board shall ensure that the Internet Web site maintained
38under subdivision (c) of Section 100502 provides a direct link to
39the formulary posted pursuant to paragraph (1) of subdivision (a)
40before the plan is offered through the Exchange.
P15 1(c) The board shall create a search tool on the Internet Web
2site maintained under subdivision (c) of Section 100502 that allows
3potential enrollees to search for qualified health plans by a
4particular drug and by a particular therapeutic condition.
5(d) For purposes of this section, “formulary for the qualified
6health plan” means the complete list of drugs preferred for use
7and eligible for coverage
under the qualified health plan and
8includes the drugs covered under both the pharmacy benefit of the
9plan and the medical benefit of the plan.
O
98