(1) 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 under authority of the Director of 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 under the authority of the Insurance Commissioner. Existing law limits the maximum amount an enrollee or insured may be required to pay at the point of sale for a covered prescription drug to the lesser of the applicable cost-sharing amount or the retail price. This bill would require an enrollee's or insured's defined cost sharing for each prescription drug to be calculated at the point of sale based on a price that is reduced by an amount equal to 90% of all rebates received, or to be received, in connection with the dispensing or administration of the drug. The bill would require a health care service plan or health insurer to, among other things, pass through to each enrollee or insured at the point of sale a good faith estimate of their decrease in cost sharing. The bill would require a health care service plan or health insurer to calculate an enrollee's or insured's defined cost sharing and provide that information to the dispensing pharmacy, as specified. The bill would require a health care service plan or health insurer to disclose information, as specified, sufficient to show compliance with these provisions to the director or commissioner. The bill would prohibit a health care service plan, health insurer, or a plan's or insurer's agents from publishing or otherwise revealing information regarding the actual amount of rebates the health care service plan or health insurer receives on a product-specific, manufacturer-specific, or pharmacy-specific basis. The bill would make a violation of its provisions not a crime under the act. The bill would authorize the director or commissioner to assess a civil penalty for each violation of these provisions, as specified. The bill would make those provisions inoperative on January 1, 2025. The bill would require the department and the commissioner, on or before March 1 each year, to provide a report on the impact of those provisions on drug prices and health care premium rates, as specified. The bill would repeal those provisions January 1, 2026. (2) Existing law requires a health care service plan or health insurer that files certain rate information to report to the appropriate department specified cost information regarding covered prescription drugs, including generic drugs, brand name drugs, and specialty drugs, dispensed as provided. This bill, until January 1, 2025, would require a health care service plan or health insurer to report additional information on the above-described point of sale provision. 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. (3) Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. (4) 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.
Sponsored bills
This resolution would designate the week beginning on February 21, 2022, as Eating Disorders Awareness Week.
This measure would, among other things, honor the late civil rights pioneer and icon Reverend Dr. Martin Luther King, Jr. and commemorate Dr. Martin Luther King, Jr. Day.
This measure would proclaim January 27, 2022, as Rose Ann Vuich Recognition Day, in recognition of Senator Rose Ann Vuich as the first woman elected to the California State Senate, to honor Senator Vuich's service to the Senate, and to appropriately reflect the Senator's stature and legacy.
This measure would proclaim the month of February 2022 as Teen Dating Violence Awareness and Prevention Month, and would call upon the people of California to observe the month with programs and activities that raise awareness about the dynamics of teen dating violence and that support youth in learning the skills to have safe and healthy relationships.
This measure would recognize February 7, 2022, to February 11, 2022, as National School Counseling Week.
This measure would designate the week of January 30, 2022, to February 5, 2022, inclusive, as Physician Anesthesiologist Week.
This measure would declare that passengers in motor vehicles should be educated and encouraged to advocate for their own safety and the safety of others during National Passenger Safety Week, the week of January 23 to 29, 2022, inclusive.