Bill Text: CA AB1144 | 2009-2010 | Regular Session | Amended

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Bill Title: Health care coverage: prescriptions.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2010-02-02 - From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB1144 Detail]

Download: California-2009-AB1144-Amended.html

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BILL NUMBER: AB 1144	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 4, 2009
	AMENDED IN ASSEMBLY  APRIL 13, 2009

INTRODUCED BY   Assembly Member Price

                        FEBRUARY 27, 2009

   An act to add Section 1367.225 to the Health and Safety Code, and
to add Section 10123.197 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1144, as amended, Price. Health care coverage: prescriptions.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the regulation of health care service plans by the
Department of Managed Health Care and makes a willful violation of
the act's requirements a crime. Existing law provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires a health care service plan contract or a health
insurance policy that covers prescription drug benefits to provide
specified coverage to subscribers, enrollees, and insureds.
   This bill would require a health care service plan or a health
insurer covering prescription drug benefits to  provide a written
 report  annually  to the Department of Managed Health
Care or to the Department of Insurance  that documents 
whenever it  requires   has required  an
enrollee or  an  insured to use certain pain medications
prior to providing access to a pain medication supported by a federal
Food and Drug Administration approved indication or to a pain
medication prescribed by the enrollee's or insured's health care
provider, as specified.
   Because a willful violation of the bill's requirements with
respect to health care service plans would be a crime, it would
impose a state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1367.225 is added to the Health and Safety
Code, to read:
   1367.225.  (a) A health care service plan that covers prescription
drug benefits shall  report   provide a written
report annually  to the department  documenting 
whenever it  requires   has required  an
enrollee to do any of the following  during the prior year 
:
   (1) Use a pain medication supported only by an off-label
indication prior to providing access to a drug supported by a federal
Food and Drug Administration approved indication.
   (2) Use more than two formulary alternative medications prior to
providing access to a pain medication prescribed by the enrollee's
health care provider.
   (3) Use a pain medication, other than the medication prescribed by
the enrollee's health care provider, for more than seven days prior
to providing access to the prescribed medication.
   (b) The report shall include a statement describing why the plan
was authorized to impose the requirement on the enrollee.
  SEC. 2.  Section 10123.197 is added to the Insurance Code, to read:

   10123.197.  (a) A health insurer that covers prescription drug
benefits shall  report   provide a written
report annually  to the department  documenting 
whenever it  requires   has required  an
insured to do any of the following  during the prior year  :

   (1) Use a pain medication supported only by an off-label
indication prior to providing access to a drug supported by a federal
Food and Drug Administration approved indication.
   (2) Use more than two formulary alternative medications prior to
providing access to a pain medication prescribed by the insured's
health care provider.
   (3) Use a pain medication, other than the medication prescribed by
the insured's health care provider, for more than seven days prior
to providing access to the prescribed pain medication.
   (b)  the   The  report shall include a
statement describing why the insurer was authorized to impose the
requirement on the insured.
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.