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AB-1803 Pharmacy: health care coverage: claims for prescription drugs sold for retail price.(2019-2020)

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Date Published: 07/15/2019 09:00 PM
AB1803:v97#DOCUMENT

Assembly Bill No. 1803
CHAPTER 114

An act to amend, repeal, and add Section 4079 of, and to repeal Section 4079.5 of, the Business and Professions Code, relating to healing arts, and declaring the urgency thereof, to take effect immediately.

[ Approved by Governor  July 12, 2019. Filed with Secretary of State  July 12, 2019. ]

LEGISLATIVE COUNSEL'S DIGEST


AB 1803, Committee on Health. Pharmacy: health care coverage: claims for prescription drugs sold for retail price.
Existing law, the Pharmacy Law, requires a pharmacy to inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the applicable cost-sharing amount for the prescription drug, except as specified, and, if the customer pays the retail price, requires the pharmacy to submit the claim to the customer’s health care service plan or health insurer.
This bill would instead make the provision requiring the pharmacy to submit the claim to the health care service plan or health insurer operative on January 1, 2020. The bill would also repeal a provision that is similar to the provision being amended by the bill.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 4079 of the Business and Professions Code is amended to read:

4079.
 (a) A pharmacy shall inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the applicable cost-sharing amount for the prescription drug, unless the pharmacy automatically charges the customer the lower price.
(b) The payment rendered shall constitute the applicable cost sharing and shall apply to the deductible, if any, and also to the maximum out-of-pocket limit in the same manner as if the enrollee had purchased the prescription drug by paying the cost-sharing amount.
(c) A contract provision that is inconsistent with this section is void and unenforceable.
(d) The provisions of this section are severable. If any provision of this section or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.
(e) A violation of this provision shall not be grounds for disciplinary action or a criminal action.
(f) This section shall remain in effect only until January 1, 2020, and as of that date is repealed.

SEC. 2.

 Section 4079 is added to the Business and Professions Code, to read:

4079.
 (a) A pharmacy shall inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the applicable cost-sharing amount for the prescription drug, unless the pharmacy automatically charges the customer the lower price.
(b) If the customer pays the retail price, the pharmacy shall submit the claim to the health care service plan or health insurer in the same manner as if the customer had purchased the prescription drug by paying the cost-sharing amount when submitted by the network pharmacy.
(c) The payment rendered shall constitute the applicable cost sharing and shall apply to the deductible, if any, and also to the maximum out-of-pocket limit in the same manner as if the enrollee had purchased the prescription drug by paying the cost-sharing amount.
(d) A contract provision that is inconsistent with this section is void and unenforceable.
(e) The provisions of this section are severable. If any provision of this section or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.
(f) A violation of this provision shall not be grounds for disciplinary action or a criminal action.
(g) This section shall become operative on January 1, 2020.

SEC. 3.

 Section 4079.5 of the Business and Professions Code is repealed.

SEC. 4.

 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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to delay, as soon as possible, the provisions requiring pharmacies to submit health care service plan and health insurance claims until appropriate administrative systems are in place to protect public health and safety, it is necessary that this measure take effect immediately.