Bill Text: CA SB1454 | 2015-2016 | Regular Session | Amended
Bill Title: Pharmacy.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2016-11-30 - From committee without further action. [SB1454 Detail]
Download: California-2015-SB1454-Amended.html
BILL NUMBER: SB 1454 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 31, 2016
INTRODUCED BY Senator Stone
FEBRUARY 19, 2016
An act to amend Section 4001 of add
Chapter 9.6 (commencing with Section 4450) to Division 2 of the
Business and Professions Code, relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
SB 1454, as amended, Stone. Pharmacy.
Existing law, the Pharmacy Law, provides for the licensure and
regulation of pharmacists and pharmacies by the California State
Board of Pharmacy. Existing law imposes requirements on audits of
pharmacy services provided to beneficiaries of a health benefit plan,
as specified.
This bill would prohibit a pharmacy benefit manager, as defined,
from requiring that a pharmacist or pharmacy provide reimbursement to
the pharmacy benefit manager for the cost of any drug dispensed to a
patient that was properly adjudicated, as defined, except upon a
showing of fraud or malfeasance. The bill would require any improper
reimbursement made under those provisions during a specified 5-year
period to be refunded to the pharmacist or pharmacy, as specified.
The Pharmacy Law establishes in the Department of Consumer Affairs
the California State Board of Pharmacy, which consists of 13
members.
This bill would make a nonsubstantive change to these provisions.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Chapter 9.6 (commencing with Section
4450) is added to Division 2 of the Business and
Professions Code , to read:
CHAPTER 9.6. PHARMACY BENEFITS MANAGEMENT
4450. For purposes of this chapter, the following definitions
shall apply:
(a) "Improper reimbursement" means a pharmacy benefit manager has
requested and received reimbursement from a pharmacist or pharmacy in
its network for the cost of a drug dispensed to a patient that was
previously authorized and properly adjudicated, in violation of
subdivision (a) of Section 4451.
(b) "Pharmacist" or "pharmacy" has the same meaning as set forth
in Chapter 9 (commencing with Section 4000), and is a person or
entity located in this state that participates in the network of a
pharmacy benefit manager.
(c) "Pharmacy benefit manager" means an entity that performs
pharmacy benefits management.
(d) "Pharmacy benefits management" means the administration or
management of prescription drug benefits, including, but not limited
to, the procurement of prescription drugs at a negotiated rate for
dispensation within this state, the processing of prescription drug
claims, and the administration of payments related to prescription
drug claims.
(e) "Properly adjudicated" means the pharmacist or pharmacy was
explicitly authorized by the pharmacy benefit manager to dispense a
drug to a patient through its network, and the pharmacist or pharmacy
was entitled to the payment that was provided, at that point in
time, by the pharmacy benefit manager, pursuant to that
authorization.
(f) "Reimbursement" means the amount that was previously paid by a
pharmacy benefit manager to a contracted pharmacist or pharmacy for
the cost of a drug dispensed to a patient that was authorized to be
dispensed as a covered drug and properly adjudicated.
4451. (a) Notwithstanding any other law, a pharmacy benefit
manager is prohibited from requiring that a pharmacist or pharmacy
provide reimbursement to the pharmacy benefit manager for the cost of
any drug dispensed to a patient that was properly adjudicated,
except upon a showing of fraud or malfeasance.
(b) No contract entered into on or after January 1, 2017, between
a pharmacy benefit manager and a pharmacist or pharmacy shall include
a provision that conflicts with the prohibition set forth in
subdivision (a).
4452. (a) Notwithstanding any other law, a pharmacy benefit
manager that administers pharmacy benefits management in this state
that has requested and received any improper reimbursements from a
pharmacist or pharmacy pursuant to the prohibition set forth in
subdivision (a) of Section 4451 shall refund that payment to the
pharmacist or pharmacy.
(b) Subdivision (a) shall apply only to those improper
reimbursements that were received by the pharmacy benefit manager
between January 1, 2012, and January 1, 2017.
SECTION 1. Section 4001 of the Business and
Professions Code is amended to read:
4001. (a) There is in the Department of Consumer Affairs a
California State Board of Pharmacy in which the administration and
enforcement of this chapter is vested. The board is composed of 13
members.
(b) The Governor shall appoint seven competent pharmacists who
reside in different parts of the state to serve as members of the
board. The Governor shall appoint four public members, and the Senate
Committee on Rules and the Speaker of the Assembly shall each
appoint a public member who shall not be a licensee of the board, any
other board under this division, or any board referred to in Section
1000 or 3600.
(c) At least five of the seven pharmacist appointees to the board
shall be pharmacists who are actively engaged in the practice of
pharmacy. Additionally, the membership of the board shall include at
least one pharmacist representative from each of the following
practice settings: an acute care hospital, an independent community
pharmacy, a chain community pharmacy, and a long-term health care or
skilled nursing facility. The pharmacist appointees shall also
include a pharmacist who is a member of a labor union that represents
pharmacists. For the purposes of this subdivision, a "chain
community pharmacy" means a chain of 75 or more stores in California
under the same ownership, and an "independent community pharmacy"
means a pharmacy owned by a person or entity who owns no more than
four pharmacies in California.
(d) Members of the board shall be appointed for a term of four
years. No person shall serve as a member of the board for more than
two consecutive terms. Each member shall hold office until the
appointment and qualification of his or her successor or until one
year shall have elapsed since the expiration of the term for which
the member was appointed, whichever first occurs. Vacancies occurring
shall be filled by appointment for the unexpired term.
(e) Each member of the board shall receive a per diem and expenses
as provided in Section 103.
(f) This section shall remain in effect only until January 1,
2017, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2017, deletes or extends
that date. Notwithstanding any other provision of law, the repeal of
this section renders the board subject to review by the appropriate
policy committees of the Legislature.
