Today's Law As Amended


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



As Amends the Law Today
As Amends the Law on Jul 15, 2019


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) 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) (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.
(d) (c)  A contract provision that is inconsistent with this section is void and unenforceable.
(e) (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.
(f) (e)  A violation of this provision shall not be grounds for disciplinary action or a criminal action.
(g) (f)  This section shall become operative on January 1, 2020. remain in effect only until January 1, 2020, and as of that date is repealed.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.