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AB-2170 Health care coverage: prescriptions: formularies.(2009-2010)

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AB2170:v97#DOCUMENT

Amended  IN  Assembly  April 27, 2010
Amended  IN  Assembly  April 13, 2010

CALIFORNIA LEGISLATURE— 2009–2010 REGULAR SESSION

Assembly Bill
No. 2170

Introduced  by  Assembly Member Bonnie Lowenthal

February 18, 2010

An act to add Section 1374.205 to the Health and Safety Code, and to add Section 10199.485 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 2170, as amended, Bonnie Lowenthal. Health care coverage: prescriptions: formularies.
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’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law prohibits a group health care service plan or health insurer, with regard to a group contract, except as specified, from changing the premium rates or applicable copayments or coinsurances or deductibles during certain time periods.
This bill would prohibit a health care service plan or a health insurer covering prescription drug benefits and using a formulary from increasing the applicable copayments or deductibles or coinsurances for prescription drugs for the length of the contract or policy,including, but not limited to, during any open enrollment period.
Because a willful violation of the bill’s requirements with respect to health care service plans 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   Local Program: YES  

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


SECTION 1.

 Section 1374.205 is added to the Health and Safety Code, to read:

1374.205.
 (a) In addition to the prohibitions in subdivision (a) of Section 1374.20 applicable to group health care service plan contracts, and notwithstanding subdivision (b) of Section 1374.20, no health care service plan, with regard to an individual or group health care service plan contract that covers prescription drug benefits and uses a formulary, shall increase the applicable copayments or deductibles for prescription drugs for the length of the contract, including, but not limited to, during any open enrollment period.
(b) This section shall not apply to health care service plan contracts issued through a publicly funded state health care coverage program, including, but not limited to, the Medi-Cal program and the Healthy Families Program, or to Medicare supplement contracts.

SEC. 2.

 Section 10199.485 is added to the Insurance Code, to read:

10199.485.
 (a) In addition to the prohibitions in subdivision (a) of Section 10199.48 applicable to group contracts, and notwithstanding subdivision (b) of Section 10199.48, no health insurer, with regard to an individual policy or group contract that covers prescription drug benefits and uses a formulary shall increase the applicable copayments or coinsurances or deductibles for prescription drugs for the length of the policy or contract, including, but not limited to, during any open enrollment period.
(b) This section shall not apply to an individual policy or group contract issued through a publicly funded state health care coverage program, including, but not limited to, the Medi-Cal program and the Healthy Families Program, or to Medicare supplement contracts.

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.