Prescription drug benefits.

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 that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires every health care service plan that provides prescription drug benefits that maintains one or more drug formularies to provide to members of the public, upon request, a copy of the most current list of prescription drugs on the formulary. This bill would prohibit a health care service plan or health insurer that provides prescription drug benefits from requiring an enrollee or insured to use mail order pharmacy services for covered prescription drugs that are available at an in-network retail pharmacy, and would prohibit the enrollee's or insured's exercise of choice with regard to obtaining those drugs from an in-network mail order pharmacy or an in-network retail pharmacy from requiring any authorization by the plan or insurer or the prescriber. The bill would specify that these requirements would not apply to drugs that are not available in retail pharmacies due to a manufacturer's instructions or restrictions. Because a willful violation of these requirements 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.