Health care coverage: prescriptions: formularies.

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's requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law prohibits a group health care service plan or health insurer, with regard to a group contract, except as specified, from changing the premium rates or applicable copayments or coinsurances or deductibles during certain time periods. This bill would prohibit a health care service plan or a health insurer covering prescription drug benefits and using a formulary from increasing the applicable copayments or deductibles or coinsurances for prescription drugs for the length of the contract or policy. Because a willful violation of the bill's requirements with respect to health care service plans 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.