Bill Text: CA AB2779 | 2009-2010 | Regular Session | Amended

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

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Bill Title: Workers' compensation: compounded drugs.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Engrossed - Dead) 2010-08-24 - To inactive file on motion of Senator DeSaulnier. [AB2779 Detail]

Download: California-2009-AB2779-Amended.html

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BILL NUMBER: AB 2779	AMENDED
	BILL TEXT

	AMENDED IN SENATE  AUGUST 11, 2010
	AMENDED IN SENATE  JULY 15, 2010
	AMENDED IN SENATE  JUNE 22, 2010
	AMENDED IN ASSEMBLY  APRIL 8, 2010

INTRODUCED BY   Assembly Member Solorio

                        MARCH 3, 2010

   An act to add Section 5307.13 to the Labor Code, relating to
workers' compensation, and declaring the urgency thereof, to take
effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2779, as amended, Solorio. Workers' compensation: compound
medication.
   Existing law establishes a workers' compensation system,
administered by the Administrative Director of the Division of
Workers' Compensation, to compensate an employee for injuries
sustained in the course of his or her employment. Existing law
requires the administrative director,  on or before December
1, 2004, to adopt, after public hearings, a medical treatment
utilization schedule, as specified   after public
hearings, to adopt and revise periodically an official medical fee
schedule that shall establish reasonable maximum fees paid for
medical services, drugs and pharmacy services, health care facility
fees, home health care, and all other treatment, care, services, and
goods, other than physician services  .
   This bill would provide that, until the administrative director
adopts  medical treatment utilization guidelines 
 a fee schedule  governing compound medication, a compound
medication shall be  covered   reimbursable
 only if there is prior authorization for it as medically
necessary, as specified.  The bill would authorize the
administrative director to adopt regulations as necessary or
convenient to implement the above-described provisions. 
   This bill would declare that it is to take effect immediately as
an urgency statute.
   Vote: 2/3. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


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

  SECTION 1.  Section 5307.13 is added to the Labor Code, to read:
   5307.13.  (a) Until the administrative director adopts 
medical treatment utilization guidelines   a fee
schedule consistent with the requirements of this section 
governing compound medication, a compound medication shall be
 covered   reimbursable  only if there is
prior authorization for it as medically necessary  based on a
determination of all of the following:   pursuant to
Section 4610 and the compound medication meets all of the following
requirements: 
   (1) All active ingredients in the compound medication are 
medications   ingredients in drug products  that
have been approved by the federal Food and Drug Administration (FDA)
 or listed by the United States Pharmacopeia  .
   (2) The compound medication is not a copy or substitute for an
available FDA-approved product. 
   (3) The safety and effectiveness of use of the compound medication
for the prescribed indication is supported by FDA-approval or
adequate medical and scientific research.  
   (4) 
    (3)  FDA-approved alternatives to the compound
medication have been tried with therapeutic failure or patient
intolerance.
   (b) The maximum allowance for the compound medication shall not
exceed the sum of the amounts that would be allowed for the
ingredient costs and dispensing fee under regulations adopted
pursuant to Section 5307.1.
   (c) No fee shall be allowed for any compound medication unless the
 initial  billing for that compound medication
includes all information necessary for calculation of the fee
pursuant to this section  and regulations adopted by the
administrative director  . 
   (d) Nothing in this section shall be interpreted to authorize a
nonphysician to reject, as medically unnecessary, an otherwise valid
prescription for a compounded medication. To the extent applicable,
Section 4610 shall apply to requests for authorization required under
this section.  
   (e) The administrative director may adopt regulations as necessary
or convenient to implement this section. 
  SEC. 2.  This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
   Abusive billing practices for compounded drugs unreasonably
inflate the cost of workers' compensation coverage for employers and
insurers, and leave fewer dollars available for injured workers to
receive in benefits. In order to stop these abusive practices at the
earliest possible time, it is necessary for this act to take effect
immediately.