Scott Wiener
- Democratic
- Senator
- District 11
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 provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law prohibits a health care service plan contract that covers prescription drug benefits or a specified health insurance policy from limiting or excluding coverage for a drug on the basis that the drug is prescribed for a use that is different from the use for which it was approved by the federal Food and Drug Administration if specified conditions are met. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified. This bill would additionally prohibit limiting or excluding coverage of a drug, dose of a drug, or dosage form of a drug that is prescribed for off-label use if the drug has been previously covered for a chronic condition or cancer, as specified, regardless of whether or not the drug, dose, or dosage form is on the plan's or insurer's formulary. The bill would prohibit a health care service plan contract or health insurance policy from requiring additional cost sharing not already imposed for a drug that was previously approved for coverage. Because a willful violation of these provisions by a health care service plan 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.
September 1 hearing: Held in committee and under submission.
August 16 set for first hearing. Placed on suspense file.
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 12. Noes 3.) (June 27).
In Assembly. Read first time. Held at Desk.
Read third time. Passed. (Ayes 31. Noes 9. Page 1274.) Ordered to the Assembly.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 5. Noes 2. Page 1159.) (May 18).
Set for hearing May 18.
May 1 hearing: Placed on APPR suspense file.
Set for hearing May 1.
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 10. Noes 1. Page 710.) (April 12).
Set for hearing April 12.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
From printer. May be acted upon on or after February 9.
Introduced. Read first time. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB70 | HTML |
| 01/09/23 - Introduced | |
| 03/08/23 - Amended Senate | |
| 04/18/23 - Amended Senate | |
| 06/29/23 - Amended Assembly |
| Document | Format |
|---|---|
| 04/10/23- Senate Health | |
| 04/28/23- Senate Appropriations | |
| 05/20/23- Sen. Floor Analyses | |
| 06/23/23- Assembly Health | |
| 08/14/23- Assembly Appropriations |
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