Bill Text: CA AB1831 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Health care coverage: prescription drugs: refills.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Vetoed) 2016-09-28 - Vetoed by Governor. [AB1831 Detail]

Download: California-2015-AB1831-Amended.html

---

BILL NUMBER: AB 1831	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 9, 2016

INTRODUCED BY   Assembly Member Low

                        FEBRUARY 9, 2016

   An act to add Section 1367.249 to the Health and Safety Code, and
to add Section 10123.209 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1831, as amended, Low. Health care coverage: prescription
drugs: refills.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law imposes various requirements on health care service plan
contracts and health insurance policies that cover prescription drug
benefits.
   This bill would require a health care service plan contract or
health insurance policy issued, amended, or renewed on or after
 January   July  1, 2017, that provides
coverage for prescription drugs benefits to allow for early refills
of covered topical ophthalmic products  at 70% of the
predicted days of use.   according to specified
standards.  Because a willful violation of the bill's
requirements by a health care service plan would be a crime, the bill
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 1367.249 is added to the Health and Safety
Code, to read:
   1367.249.  (a) A health care service plan contract issued,
amended, or renewed on or after  January   July
 1, 2017, that provides coverage for prescription drug benefits
shall allow for early refills of covered topical ophthalmic products
 at 70 percent of the predicted days of use.  
according to the following standards:  
   (1) For a 30-day supply, at least 23 days and less than 30 days
from the later of either of the following:  
   (A) The original date that the prescription was distributed to the
enrollee.  
   (B) The date of the most recent refill that was distributed to the
enrollee.  
   (2) For a 90-day supply, at least 68 days and less than 90 days
from the later of either of the following:  
   (A) The original date that the prescription was distributed to the
enrollee.  
   (B) The date of the most recent refill that was distributed to the
enrollee.  
   (3) The refills requested by the enrollee do not exceed the number
of additional quantities prescribed by the enrollee's participating
health plan provider.  
   (b) Nothing in this section shall prevent a plan contract from
allowing for early refills at 70 percent of the predicted days of
use.  
   (b) 
    (c)  Nothing in this section shall be construed to
establish a new mandated benefit or to prevent the application of
deductible or copayment provisions in a plan contract.
  SEC. 2.  Section 10123.209 is added to the Insurance Code, to read:

   10123.209.  (a) A health insurance policy issued, amended, or
renewed on or after  January   July  1,
2017, that provides coverage for prescription drug benefits shall
allow for early refills of covered topical ophthalmic products
 at 70 percent of the predicted days of use.  
according to the following standards:  
   (1) For a 30-day supply, at least 23 days and less than 30 days
from the later of either of the following:  
   (A) The original date that the prescription was distributed to the
insured.  
   (B) The date of the most recent refill that was distributed to the
insured.  
   (2) For a 90-day supply, at least 68 days and less than 90 days
from the later of either of the following:  
   (A) The original date that the prescription was distributed to the
insured.  
   (B) The date of the most recent refill that was distributed to the
insured.  
   (3) The refills requested by the insured do not exceed the number
of additional quantities prescribed by the insured's participating
health plan provider.  
   (b) Nothing in this section shall prevent a health insurance
policy from allowing for early refills at 70 percent of the predicted
days of use.  
   (b) 
    (c)  Nothing in this section shall be construed to
establish a new mandated benefit or to prevent the application of
deductible or copayment provisions in a health insurance policy.
  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.