Today's Law As Amended


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AB-310 Prescription drugs.(2011-2012)



As Amends the Law Today


SECTION 1.

 Section 1367.225 is added to the Health and Safety Code, to read:

1367.225.
 (a) A health care service plan contract issued, amended, or renewed on or after January 1, 2012, that covers outpatient prescription drugs shall not require coinsurance as a basis for cost sharing with the enrollee for outpatient prescription drug benefits.
(b) A health care service plan contract issued, amended, or renewed on or after January 1, 2012, shall not require an enrollee to pay a copayment for outpatient prescription drugs in excess of one hundred fifty dollars ($150) for a one-month supply of a prescription, or its equivalent for a prescription for a longer period, as adjusted for inflation.
(c) If a health care service plan contract provides for a limit on the annual out-of-pocket expenses for an enrollee, the enrollee’s out-of-pocket costs of covered prescription drugs shall be included in that limit.
(d) (1) For purposes of this section, “coinsurance” means a cost-sharing payment by an enrollee that is based on a percentage of the cost for a prescription.
(2) For purposes of this section, “copayment” means a flat dollar amount an enrollee is required to pay in cost sharing for covered health services, items, and supplies, including prescription drugs, after any applicable deductible. The term shall not be construed to include any other forms of cost sharing.
(e) Nothing in this section shall be construed to require a health care service plan contract to provide coverage not otherwise required by law for any prescription drug.
(f) This section shall become inoperative upon a determination by the department that the requirements of this section would result in the assumption by the state of additional costs pursuant to Section 1311(d)(3)(B) of the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by Section 10104(e) of Title X of that act, relative to benefits required by the state to be offered by qualified plans in the California Health Benefit Exchange that exceed the requirements imposed by federal law.

SEC. 2.

 Section 10123.197 is added to the Insurance Code, to read:

10123.197.
 (a) A health insurance policy issued, amended, or renewed on or after January 1, 2012, that covers outpatient prescription drugs shall not require coinsurance as a basis for cost sharing with the insured for outpatient prescription drug benefits.
(b) A health insurance policy issued, amended, or renewed on or after January 1, 2012, shall not require an insured to pay a copayment for outpatient prescription drugs in excess of one hundred fifty dollars ($150) for a one-month supply of a prescription, or its equivalent for a prescription for a longer period, as adjusted for inflation.
(c) If a health insurance policy provides for a limit on the annual out-of-pocket expenses for an insured, the insured’s out-of-pocket costs of covered prescription drugs shall be included in that limit.
(d) (1) For purposes of this section, “coinsurance” means a cost-sharing payment by an insured that is based on a percentage of the cost for a prescription.
(2) For purposes of this section, “copayment” means a flat dollar amount an insured is required to pay in cost sharing for covered health services, items, and supplies, including prescription drugs, after any applicable deductible. The term shall not be construed to include any other forms of cost sharing.
(e) Nothing in this section shall be construed to require a health insurance policy to provide coverage not otherwise required by law for any prescription drug.
(f) This section shall become inoperative upon a determination by the commissioner that the requirements of this section would result in the assumption by the state of additional costs pursuant to Section 1311(d)(3)(B) of the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by Section 10104(e) of Title X of that act, relative to benefits required by the state to be offered by qualified plans in the California Health Benefit Exchange that exceed the requirements imposed by federal law.
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.