Individual legislator voting records for this vote are not currently available. Includes all politicians who were in office at any point during the 2015-2016 Legislature.

AB 339 - An Act to Amend Section 1367.205 Of, to Add Sections 1367.41 and 1367.42 To, and to Add and Repeal Section 1342.71 Of, the Health and Safety Code, and to Amend Section 10123.192 Of, to Add Section 10123.201 To, and to Add and Repeal Section 10123.193 Of, the Insurance Code, Relating to Health Care Coverage.

Health care coverage: outpatient prescription drugs. 2015-2016 Legislature. View bill details
Author(s):
Summary:
(1)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 a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or insurer that… More
(1)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 a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or insurer that provides prescription drug benefits and maintains one or more drug formularies to make specified information regarding the formularies available to the public and other specified entities. Existing law also specifies requirements for those plans and insurers regarding coverage and cost sharing of specified prescription drugs.

This bill would prohibit the formulary or formularies for outpatient prescription drugs maintained by a health care service plan or health insurer from discouraging the enrollment of individuals with health conditions and from reducing the generosity of the benefit for enrollees or insureds with a particular condition. The bill, until January 1, 2020, would provide that the copayment, coinsurance, or any other form of cost sharing for a covered outpatient prescription drug for an individual prescription shall not exceed $250 for a supply of up to 30 days, except as specified, and would prohibit, for a nongrandfathered individual or small group plan contract or policy, the annual deductible for outpatient drugs from exceeding a specified amount. The bill would make these cost-sharing limits applicable only to covered outpatient prescription drugs that constitute essential health benefits, as defined. The bill would require a plan contract or policy to cover a single-tablet prescription drug regimen for combination antiretroviral drug treatments that are medically necessary for the treatment of AIDS/HIV, as specified. The bill, until January 1, 2020, would require a nongrandfathered individual or small group plan contract or policy to use specified definitions for each tier of a drug formulary. The bill would make related findings and declarations.

This bill would require a health care service plan contract or health insurance policy that provides coverage for outpatient prescription drugs to provide coverage for medically necessary prescription drugs, including nonformulary drugs determined to be medically necessary, and, for an insurer, would require copayments, coinsurance, and other cost sharing for outpatient prescription drugs to be reasonable.

This bill would make these provisions applicable to nongrandfathered health care service plan contracts or health insurance policies that are offered, renewed, or amended on or after January 1, 2017.

(2)Existing law requires every health care service plan that provides prescription drug benefits to maintain specified information that is required to be made available to the Director of the Department of Managed Health Care upon request.

This bill would also impose these requirements on a health insurer that provides prescription drug benefits, as provided. The bill would authorize an insurer to require step therapy, as defined, when more than one drug is appropriate for the treatment of a medical condition, subject to specified requirements. The bill, with regard to an insured changing policies, would prohibit a new insurer from requiring the insured to repeat step therapy when that person is already being treated for a medical condition by a prescription drug, as specified. For plan years commencing on or after January 1, 2017, the bill, except as specified, would require a plan or insurer that provides essential health benefits to allow an enrollee or insured to access his or her prescription drug benefits at an in-network retail pharmacy, and would authorize a nongrandfathered individual or small group plan or insurer to charge an enrollee or insured a different cost sharing for obtaining a covered drug at a retail pharmacy, and would require that cost-sharing amount to count towards the plan’s or insurer’s annual out-of-pocket limitation, as specified.

This bill, commencing January 1, 2017, would require a plan or insurer to maintain a pharmacy and therapeutics committee that is responsible for developing, maintaining, and overseeing any drug formulary list, as provided. The bill would require the committee to, among other things, evaluate and analyze treatment protocols and procedures related to the plan’s or insurer’s drug formulary at least annually.

(3)Existing law requires the Department of Managed Health Care and the Department of Insurance to jointly develop a standard formulary template by January 1, 2017, and requires plans and insurers to use that template to display formularies, as specified. Existing law requires the standard formulary template to include specified information.

This bill would require the standard formulary template to include additional specified information, including which medications are covered, including both generic and brand name.

(4)Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, this 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. Hide
 
Status:
The bill has become law (chaptered). 
Assembly Vote: On Passage

PASSED on September 11, 2015.

voted YES: 50 voted NO: 27
3 voted present/not voting

An Act to Amend Section 1367.205 Of, to Add Sections 1367.41 and 1367.42 To, and to Add and Repeal Section 1342.71 Of, the Health and Safety Code, and to Amend Section 10123.192 Of, to Add Section 10123.201 To, and to Add and Repeal Section 10123.193 Of, the Insurance Code, Relating to Health Care Coverage.

AB 339 — 2015-2016 Legislature

Summary
(1)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 a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or insurer that provides prescription drug benefits and maintains one or more drug formularies to make specified information regarding the formularies available to the public and other specified entities. Existing law also specifies requirements for those plans and insurers regarding coverage and cost sharing of specified prescription drugs.

This bill would prohibit the formulary or formularies for outpatient prescription drugs maintained by a health care service plan or health insurer from discouraging the enrollment of individuals with health conditions and from reducing the generosity of the benefit for enrollees or insureds with a particular condition. The bill, until January 1, 2020, would provide that the copayment, coinsurance, or any other form of cost sharing for a covered outpatient… More
(1)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 a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or insurer that provides prescription drug benefits and maintains one or more drug formularies to make specified information regarding the formularies available to the public and other specified entities. Existing law also specifies requirements for those plans and insurers regarding coverage and cost sharing of specified prescription drugs.

This bill would prohibit the formulary or formularies for outpatient prescription drugs maintained by a health care service plan or health insurer from discouraging the enrollment of individuals with health conditions and from reducing the generosity of the benefit for enrollees or insureds with a particular condition. The bill, until January 1, 2020, would provide that the copayment, coinsurance, or any other form of cost sharing for a covered outpatient prescription drug for an individual prescription shall not exceed $250 for a supply of up to 30 days, except as specified, and would prohibit, for a nongrandfathered individual or small group plan contract or policy, the annual deductible for outpatient drugs from exceeding a specified amount. The bill would make these cost-sharing limits applicable only to covered outpatient prescription drugs that constitute essential health benefits, as defined. The bill would require a plan contract or policy to cover a single-tablet prescription drug regimen for combination antiretroviral drug treatments that are medically necessary for the treatment of AIDS/HIV, as specified. The bill, until January 1, 2020, would require a nongrandfathered individual or small group plan contract or policy to use specified definitions for each tier of a drug formulary. The bill would make related findings and declarations.

This bill would require a health care service plan contract or health insurance policy that provides coverage for outpatient prescription drugs to provide coverage for medically necessary prescription drugs, including nonformulary drugs determined to be medically necessary, and, for an insurer, would require copayments, coinsurance, and other cost sharing for outpatient prescription drugs to be reasonable.

This bill would make these provisions applicable to nongrandfathered health care service plan contracts or health insurance policies that are offered, renewed, or amended on or after January 1, 2017.

(2)Existing law requires every health care service plan that provides prescription drug benefits to maintain specified information that is required to be made available to the Director of the Department of Managed Health Care upon request.

This bill would also impose these requirements on a health insurer that provides prescription drug benefits, as provided. The bill would authorize an insurer to require step therapy, as defined, when more than one drug is appropriate for the treatment of a medical condition, subject to specified requirements. The bill, with regard to an insured changing policies, would prohibit a new insurer from requiring the insured to repeat step therapy when that person is already being treated for a medical condition by a prescription drug, as specified. For plan years commencing on or after January 1, 2017, the bill, except as specified, would require a plan or insurer that provides essential health benefits to allow an enrollee or insured to access his or her prescription drug benefits at an in-network retail pharmacy, and would authorize a nongrandfathered individual or small group plan or insurer to charge an enrollee or insured a different cost sharing for obtaining a covered drug at a retail pharmacy, and would require that cost-sharing amount to count towards the plan’s or insurer’s annual out-of-pocket limitation, as specified.

This bill, commencing January 1, 2017, would require a plan or insurer to maintain a pharmacy and therapeutics committee that is responsible for developing, maintaining, and overseeing any drug formulary list, as provided. The bill would require the committee to, among other things, evaluate and analyze treatment protocols and procedures related to the plan’s or insurer’s drug formulary at least annually.

(3)Existing law requires the Department of Managed Health Care and the Department of Insurance to jointly develop a standard formulary template by January 1, 2017, and requires plans and insurers to use that template to display formularies, as specified. Existing law requires the standard formulary template to include specified information.

This bill would require the standard formulary template to include additional specified information, including which medications are covered, including both generic and brand name.

(4)Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, this 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. Hide
Learn More
At LegInfo.ca.gov
Title
An Act to Amend Section 1367.205 Of, to Add Sections 1367.41 and 1367.42 To, and to Add and Repeal Section 1342.71 Of, the Health and Safety Code, and to Amend Section 10123.192 Of, to Add Section 10123.201 To, and to Add and Repeal Section 10123.193 Of, the Insurance Code, Relating to Health Care Coverage.
Author(s)
Rich Gordon
Co-Authors
Subjects
  • Health care coverage: outpatient prescription drugs
Major Actions
Introduced2/13/2015
Referred to Committee
Passed Assembly Committee on Health4/28/2015
Passed Assembly Committee on Appropriations5/28/2015
Passed Assembly6/03/2015
Passed Senate Committee on Health7/15/2015
Passed Senate Committee on Appropriations8/17/2015
Passed Senate Committee on Appropriations8/27/2015
Passed Senate9/10/2015
Passed Assembly9/11/2015
Presented to the governor (enrolled)9/23/2015
Became law (chaptered).10/08/2015
Bill History
Chamber/CommitteeMotionDateResult
select this voteAssembly Committee on HealthDo pass as amended and be re-referred to the Committee on [Appropriations]4/28/2015This motion PASSED the Assembly Committee on Health
12 voted YES 5 voted NO 0 voted present/not voting
select this voteAssembly Committee on AppropriationsDo pass as amended.5/28/2015This motion PASSED the Assembly Committee on Appropriations
12 voted YES 5 voted NO 0 voted present/not voting
select this voteAssemblyAB 339 GORDON Assembly Third Reading6/03/2015This bill PASSED the Assembly
48 voted YES 30 voted NO 2 voted present/not voting
select this voteSenate Committee on HealthDo pass as amended, but first amend, and re-refer to the Committee on [Appropriations]7/15/2015This motion PASSED the Senate Committee on Health
7 voted YES 2 voted NO 0 voted present/not voting
select this voteSenate Committee on AppropriationsPlaced on suspense file8/17/2015This motion PASSED the Senate Committee on Appropriations
7 voted YES 0 voted NO 0 voted present/not voting
select this voteSenate Committee on AppropriationsDo pass as amended8/27/2015This motion PASSED the Senate Committee on Appropriations
5 voted YES 2 voted NO 0 voted present/not voting
select this voteSenateAssembly 3rd Reading AB339 Gordon By Monning9/10/2015This bill PASSED the Senate
25 voted YES 13 voted NO 2 voted present/not voting
currently selectedAssemblyAB 339 GORDON Concurrence in Senate Amendments9/11/2015This bill PASSED the Assembly
50 voted YES 27 voted NO 3 voted present/not voting
ActionDateDescription
Introduced2/13/2015
2/13/2015Read first time. To print.
2/17/2015From printer. May be heard in committee March 19.
2/23/2015Referred to Com. on HEALTH.
4/07/2015From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
4/08/2015Re-referred to Com. on HEALTH.
select this voteVote4/28/2015Do pass as amended and be re-referred to the Committee on [Appropriations]
4/30/2015From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 12. Noes 5.) (April 28).
5/04/2015Read second time and amended.
5/05/2015Re-referred to Com. on APPR.
5/20/2015From committee chair, with author's amendments: Amend, and re-refer to Com. on APPR. Read second time and amended.
5/21/2015Re-referred to Com. on APPR.
5/27/2015In committee: Set, first hearing. Referred to APPR. suspense file.
select this voteVote5/28/2015Do pass as amended.
5/28/2015Joint Rule 62(a), file notice suspended. (Page 1613.) From committee: Amend, and do pass as amended. (Ayes 12. Noes 5.) (May 28).
6/01/2015Read second time and amended. Ordered returned to second reading.
6/02/2015Read second time. Ordered to third reading.
6/03/2015Read third time. Passed. Ordered to the Senate. (Ayes 48. Noes 30. Page 1867.)
6/03/2015In Senate. Read first time. To Com. on RLS. for assignment.
select this voteAssembly Vote on Passage6/03/2015AB 339 GORDON Assembly Third Reading
6/18/2015Referred to Com. on HEALTH.
6/24/2015From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.
7/01/2015In committee: Set, first hearing. Hearing canceled at the request of author.
7/07/2015From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.
select this voteVote7/15/2015Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]
7/16/2015From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 2.) (July 15). Read second time and amended. Re-referred to Com. on APPR.
select this voteVote8/17/2015Placed on suspense file
8/17/2015In committee: Referred to APPR. suspense file.
select this voteVote8/27/2015Do pass as amended
8/31/2015From committee: Amend, and do pass as amended. (Ayes 5. Noes 2.) (August 27).
9/01/2015Read second time and amended. Ordered to third reading.
9/04/2015Read third time and amended. Ordered to second reading.
9/08/2015Read second time. Ordered to third reading.
9/10/2015Read third time. Passed. Ordered to the Assembly. (Ayes 25. Noes 13. Page 2694.).
9/10/2015In Assembly. Concurrence in Senate amendments pending.
select this voteSenate Vote on Passage9/10/2015Assembly 3rd Reading AB339 Gordon By Monning
9/11/2015Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 50. Noes 27. Page 3138.).
currently selectedAssembly Vote on Passage9/11/2015AB 339 GORDON Concurrence in Senate Amendments
9/23/2015Enrolled and presented to the Governor at 4 p.m.
10/08/2015Approved by the Governor.
10/08/2015Chaptered by Secretary of State - Chapter 619, Statutes of 2015.

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An Act to Amend Section 1367.205 Of, to Add Sections 1367.41 and 1367.42 To, and to Add and Repeal Section 1342.71 Of, the Health and Safety Code, and to Amend Section 10123.192 Of, to Add Section 10123.201 To, and to Add and Repeal Section 10123.193 Of, the Insurance Code, Relating to Health Care Coverage.: AB 339 GORDON Concurrence in Senate Amendments

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Includes reported contributions to campaigns of Assemblymembers in office on day of vote, from interest groups invested in the vote according to MapLight, January 1, 2011 – December 31, 2012.
Contributions data source: FollowTheMoney.org

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Katcho AchadjianRCA-35$0$0
Luis AlejoDCA-30$0$0
Travis AllenRCA-72$0$0
Toni G. AtkinsDCA-78$0$0
Catharine B. BakerRCA-16$0$0
Frank BigelowRCA-5$0$0
Richard BloomDCA-50$0$0
Susan BonillaDCA-14$0$0
Rob BontaDCA-18$0$0
William P. BroughRCA-73$0$0
Cheryl BrownDCA-47$0$0
Autumn R. BurkeDCA-62$0$0
Ian C. CalderonDCA-57$0$0
Nora CamposDCA-27$0$0
Ling Ling ChangRCA-55$0$0
Ed ChauDCA-49$0$0
Rocky J. ChavezRCA-76$0$0
David ChiuDCA-17$0$0
Kansen ChuDCA-25$0$0
Ken CooleyDCA-8$0$0
Jim CooperDCA-9$0$0
Matthew DababnehDCA-45$0$0
Brian DahleRCA-1$0$0
Tom DalyDCA-69$0$0
Bill DoddDCA-4$0$0
Susan Talamantes EggmanDCA-13$0$0
Jim FrazierDCA-11$0$0
Beth GainesRCA-6$0$0
James GallagherRCA-3$0$0
Cristina GarciaDCA-58$0$0
Eduardo GarciaDCA-56$0$0
Mike GattoDCA-43$0$0
Mike A. GipsonDCA-64$0$0
Jimmy GomezDCA-51$0$0
Lorena S. GonzalezDCA-80$0$0
Rich GordonDCA-24$0$0
Adam C. GrayDCA-21$0$0
Shannon GroveRCA-34$0$0
David HadleyRCA-66$0$0
Matthew HarperRCA-74$0$0
Roger HernandezDCA-48$0$0
Chris R. HoldenDCA-41$0$0
Jacqui IrwinDCA-44$0$0
Brian JonesRCA-71$0$0
Reginald B. Jones-Sawyer, Sr.DCA-59$0$0
Young O. KimRCA-65$0$0
Tom LackeyRCA-36$0$0
Marc LevineDCA-10$0$0
Eric LinderRCA-60$0$0
Patty LopezDCA-39$0$0
Evan LowDCA-28$0$0
Brian MaienscheinRCA-77$0$0
Devon J. MathisRCA-26$0$0
Chad MayesRCA-42$0$0
Kevin McCartyDCA-7$0$0
Jose MedinaDCA-61$0$0
Melissa A. MelendezRCA-67$0$0
Kevin MullinDCA-22$0$0
Adrin NazarianDCA-46$0$0
Patrick O'DonnellDCA-70$0$0
Jay ObernolteRCA-33$0$0
Kristin OlsenRCA-12$0$0
Jim PattersonRCA-23$0$0
Henry PereaDCA-31$0$0
Bill QuirkDCA-20$0$0
Anthony RendonDCA-63$0$0
Sebastian Ridley-ThomasDCA-54$0$0
Freddie RodriguezDCA-52$0$0
Rudy SalasDCA-32$0$0
Miguel SantiagoDCA-53$0$0
Marc SteinorthRCA-40$0$0
Mark StoneDCA-29$0$0
Tony ThurmondDCA-15$0$0
Philip Y. TingDCA-19$0$0
Don WagnerRCA-68$0$0
Marie WaldronRCA-75$0$0
Shirley N. WeberDCA-79$0$0
Scott WilkRCA-38$0$0
Das WilliamsDCA-37$0$0
Jim WoodDCA-2$0$0

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