Bill Text: CA AB2863 | 2017-2018 | Regular Session | Amended

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

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Bill Title: Health care coverage: prescriptions.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Passed) 2018-09-26 - Chaptered by Secretary of State - Chapter 770, Statutes of 2018. [AB2863 Detail]

Download: California-2017-AB2863-Amended.html

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Amended  IN  Assembly  March 23, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill

No. 2863

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Introduced by Assembly Member Nazarian

February 16, 2018

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An act to amend Section 4073 of add Section 4445 to the Business and Professions Code, relating to pharmacy.

LEGISLATIVE COUNSEL'S DIGEST

AB 2863, as amended, Nazarian. Pharmacy: prescriptions. prescriptions: pharmacy benefit manager: cost.

The Pharmacy Law provides for the licensing and regulation of the practice of pharmacy under the jurisdiction of the California State Board of Pharmacy within the Department of Consumer Affairs. Existing law establishes requirements for prescriptions, including specific requirements for the substitution of drugs on filling a prescription order.

This bill would make nonsubstantive changes to those substitution provisions.

Existing law requires a pharmacy benefit manager that reimburses a contracting pharmacy for a drug on a maximum allowable cost basis to include information identifying any national drug pricing compendia or other data sources used to determine the maximum allowable cost for the drugs on a maximum allowable cost list and to provide for an appeal process for the contracting pharmacy in any contract entered into or renewed on or after January 1, 2016. Existing law requires a pharmacy benefit manager to make available to a contracting pharmacy, upon request, the most up-to-date maximum allowable cost list or lists used by the pharmacy benefit manager for patients served by the pharmacy.

This bill would prohibit a contract between a health carrier or a pharmacy benefit manager and a pharmacy from penalizing a pharmacy’s disclosure of the cost of the prescription medication or the availability of alternative medications or less costly alternative methods of purchasing a medication to a health benefit plan beneficiary. The bill would limit the amount a health carrier or pharmacy benefit manager may require a health benefit plan beneficiary to pay at the point of sale for a covered prescription medication to the lesser of the applicable cost-sharing amount or the amount the beneficiary would pay without using a health benefit plan. The bill would prohibit a health carrier or pharmacy benefit manager from requiring a pharmacy to charge or collect a copayment from a beneficiary that exceeds the total submitted charges by the network pharmacy. The bill would require the amount paid for a prescription to be applied to the beneficiary’s deductible and out-of-pocket maximum if the beneficiary opts to pay the cash price.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NO   Local Program: NO  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 Section 4445 is added to the Business and Professions Code, to read:

4445.

 (a) A contract entered into or renewed on or after January 1, 2019, between a health carrier or a pharmacy benefit manager and a pharmacist or pharmacy may not penalize a pharmacist’s or pharmacy’s disclosure of any of the following information to a health benefit plan beneficiary purchasing prescription medication:

(1) The cost of the prescription medication to the beneficiary.

(2) The availability of any therapeutically equivalent alternative medications or alternative methods of purchasing the prescription medication that are less expensive than the cost of the prescription medication to the beneficiary, including, but not limited to, paying the cash price.

(b) The maximum amount a health carrier or pharmacy benefit manager may require a health benefit plan beneficiary to pay at the point of sale for a covered prescription medication is the lesser of the following:

(1) The applicable cost-sharing amount for the prescription medication.

(2) The amount the beneficiary would pay for the prescription medication if the beneficiary purchased the prescription medication without using a health benefit plan or any other source of prescription medication benefits or discounts.

(c) A health carrier or pharmacy benefit manager shall not require a pharmacist or pharmacy to charge or collect from a beneficiary a copayment that exceeds the total submitted charges by the network pharmacy. If a beneficiary pays the amount specified in paragraph (2) of subdivision (b) instead of paying the cost-sharing amount for the prescription medication, that amount shall be applied to the beneficiary’s deductible and out-of-pocket maximum in the same manner as if the beneficiary had purchased the prescription medication by paying the cost-sharing amount.

SECTION 1.Section 4073 of the Business and Professions Code is amended to read:

4073.

(a)A pharmacist filling a prescription order for a drug product prescribed by its trade or brand name may select another drug product with the same active chemical ingredients of the same strength, quantity, and dosage form, and of the same generic drug name as determined by the United States Adopted Names Council and accepted by the federal Food and Drug Administration, of those drug products having the same active chemical ingredients.

(b)A selection shall not be made pursuant to this section if the prescriber personally indicates, either orally or in his or her own handwriting, “Do not substitute,” or words of similar meaning. Nothing in this subdivision shall prohibit a prescriber from checking a box on a prescription marked “Do not substitute”; provided that the prescriber personally initials the box or checkmark. To indicate that a selection shall not be made pursuant to this section for an electronic data transmission prescription as defined in subdivision (c) of Section 4040, a prescriber may indicate “Do not substitute,” or words of similar meaning, in the prescription as transmitted by electronic data, or may check a box marked on the prescription “Do not substitute.” In either instance, it shall not be required that the prohibition on substitution be manually initialed by the prescriber.

(c)Selection pursuant to this section is within the discretion of the pharmacist, except as provided in subdivision (b). The person who selects the drug product to be dispensed pursuant to this section shall assume the same responsibility for selecting the dispensed drug product as would be incurred in filling a prescription for a drug product prescribed by generic name. There shall be no liability on the prescriber for an act or omission by a pharmacist in selecting, preparing, or dispensing a drug product pursuant to this section. The pharmacist shall not select a drug product pursuant to this section unless the drug product selected costs the patient less than the prescribed drug product. “Cost,” as used in this subdivision, is defined to include any professional fee that may be charged by the pharmacist.

(d)This section shall apply to all prescriptions, including those presented by or on behalf of persons receiving assistance from the federal government or pursuant to the Medi-Cal Act (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code).

(e)When a substitution is made pursuant to this section, the use of the cost-saving drug product dispensed shall be communicated to the patient and the name of the dispensed drug product shall be indicated on the prescription label, except where the prescriber orders otherwise.