Marc Berman
- Democratic
- Assemblymember
- District 23
Author
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 prohibits the copayment, coinsurance, or any other form of cost sharing for a covered outpatient prescription drug for an individual prescription from exceeding $250 for a supply of up to 30 days, except as specified. Existing law requires a health care service plan contract or health insurance policy for a nongrandfathered individual or small group product that maintains a drug formulary grouped into tiers, and that includes a 4th tier, to define each tier of the drug formulary, as specified. Existing law defines Tier 4 to include, among others, drugs that are biologics. Existing law repeals these provisions on January 1, 2024. This bill would delete drugs that are biologics from the definition of Tier 4. The bill would require a health care service plan or a health insurer, if there is a generic equivalent to a brand name drug, to ensure that an enrollee or insured is subject to the lowest cost sharing that would be applied, whether or not both the generic equivalent and the brand name drug are on the formulary. The bill also would delete the January 1, 2024, repeal date of the above provisions, thus making them operative indefinitely. Because extension of the bill's requirements relative to health care service plans would extend the existence of 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.
Chaptered by Secretary of State - Chapter 820, Statutes of 2023.
Approved by the Governor.
Enrolled and presented to the Governor at 4:30 p.m.
Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 79. Noes 0. Page 3025.).
Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0. Page 2360.).
In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 7 pursuant to Assembly Rule 77.
Read second time. Ordered to third reading.
Read third time and amended. Ordered to second reading.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 6. Noes 0.) (June 26).
Read second time and amended. Re-referred to Com. on APPR.
From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 12. Noes 0.) (June 7).
In Senate. Read first time. To Com. on RLS. for assignment.
Read third time. Passed. Ordered to the Senate. (Ayes 79. Noes 0. Page 1365.)
Read second time. Ordered to Consent Calendar.
From committee: Do pass. To Consent Calendar. (Ayes 14. Noes 0.) (April 19).
From committee: Do pass and re-refer to Com. on APPR. (Ayes 13. Noes 0.) (March 21). Re-referred to Com. on APPR.
From printer. May be heard in committee March 17.
Read first time. To print.
| Bill Text Versions | Format |
|---|---|
| AB948 | HTML |
| 02/14/23 - Introduced | |
| 06/12/23 - Amended Senate | |
| 08/14/23 - Amended Senate | |
| 09/11/23 - Enrolled | |
| 10/13/23 - Chaptered |
| Document | Format |
|---|---|
| 03/17/23- Assembly Health | |
| 04/18/23- Assembly Appropriations | |
| 06/05/23- Senate Health | |
| 06/23/23- Senate Appropriations | |
| 06/28/23- Sen. Floor Analyses | |
| 08/16/23- Sen. Floor Analyses | |
| 09/05/23- ASSEMBLY FLOOR ANALYSIS |
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