Health care coverage: prescriptions.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act's requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or a health insurance policy that covers prescription drug benefits to provide specified coverage to subscribers, enrollees, and insureds. This bill would require a health care service plan or a health insurer covering prescription drug benefits to provide a written report annually to the Department of Managed Health Care or to the Department of Insurance that documents whenever it has required an enrollee or an insured to use certain pain medications prior to providing access to a pain medication supported by a federal Food and Drug Administration approved indication or to a pain medication prescribed by the enrollee's or insured's health care provider, as specified. Because a willful violation of the bill's requirements with respect to health care service plans would be a crime, it 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.