Health care coverage: prescription drugs: continuity of care.
As a result of AB 1353, health care service plans and insurers will have to improve their procedures for managing the coverage of outpatient prescription drugs, particularly concerning continuity of care for enrollees. This bill specifically mandates that health plans respond to exception requests within a stipulated timeframe, with an aim to prevent delays in access to medically necessary treatments. The law emphasizes maintaining access to medications that are vital for the health of the patients, especially those who have been stabilized on a specific drug regimen over the past 100 days before the bill's enactment.
Assembly Bill 1353, introduced by Assembly Member Waldron, aims to enhance health care coverage related to outpatient prescription drugs by mandating health care service plans and health insurers to establish an expedited process for exception requests to prior authorization practices. Specifically, the bill requires that the processes for obtaining exceptions be quicker and that enrollees or their prescribing providers can secure coverage for nonformulary drugs that are medically necessary, particularly when these drugs have been previously covered by the insurer and are safe and effective for the enrollee's condition. The overarching goal is to ensure seamless continuity of care for patients undergoing treatment with specific medications.
The sentiment surrounding AB 1353 appears largely supportive among advocates for patient rights and healthcare access, as it addresses significant concerns regarding the obstacles posed by prior authorization processes that often complicate and delay necessary treatments. However, there are concerns about the implications for insurers regarding the management of such requests and the potential increase in costs associated with adhering to the new requirements. Balancing the need for efficient care with the financial interests of insurers has led to contentious discussions among stakeholders.
Notable points of contention regarding AB 1353 include the potential challenges health care service plans may face in implementing the new protocols within the mandated timeframes, and whether they can adequately manage the change in processes without incurring additional costs. There are also worries regarding how this bill will interact with existing regulations on insurance and patient care standards, particularly about limiting the flexibility of insurers in managing drug formularies and the potential for increased premiums as a result.