Amended IN Assembly March 12, 2020 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2983Introduced by Assembly Member HoldenFebruary 21, 2020An act to amend Section 14105.455 of the Welfare and Institutions Code, relating to Medi-Cal. An act to add Section 4063.5 to the Business and Professions Code, relating to healing arts.LEGISLATIVE COUNSEL'S DIGESTAB 2983, as amended, Holden. Pharmacy provider: billing. Pharmacies: automatic refills.Existing law, the Pharmacy Law, provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy, and makes a willful violation of those provisions a misdemeanor. Existing law prohibits a prescription for any dangerous drug or dangerous device to be refilled except upon authorization of the prescriber.This bill would prohibit a pharmacy from automatically contacting a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a 7-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The bill would require a pharmacy to obtain separate authorization for each prescription and would prohibit a pharmacy from requesting more than the number of refills authorized in the original prescription. Because the bill would expand the scope of 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. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Pursuant to a schedule of benefits, these services include prescription drugs that are subject to the Medi-Cal List of Contract Drugs. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law requires pharmacy providers to submit their usual and customary charge when billing the Medi-Cal program for prescribed drugs, and to keep and maintain records of those charges for a period of 3 years from the date the service was rendered.This bill would prohibit pharmacy providers from billing the Medi-Cal program for any prescribed drug that has been automatically filled, regardless of whether that prescribed drug has been dispensed by mail order or retail.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOYES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 4063.5 is added to the Business and Professions Code, to read:4063.5. A pharmacy shall not automatically contact a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a seven-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The pharmacy shall obtain separate authorization to automatically contact the prescriber for each prescription and shall not request more than the number of refills authorized in the original prescription.SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.SECTION 1.Section 14105.455 of the Welfare and Institutions Code is amended to read:14105.455.(a)A pharmacy provider shall submit their usual and customary charge when billing the Medi-Cal program for any prescribed drug, except as specified in subdivision (f).(b)Usual and customary charge means the lower of the following:(1)The lowest price reimbursed to the pharmacy by a third-party payer in California, excluding any Medi-Cal managed care plan and Medicare Part D prescription drug plan.(2)The lowest price routinely offered to any segment of the general public.(c)Any donation or discount provided to a charitable organization is not considered a usual and customary charge.(d)A pharmacy provider shall keep and maintain records of any usual and customary charge for a period of three years from the date that they rendered the service.(e)Payment to a pharmacy provider shall be the lower of the pharmacys usual and customary charge or the reimbursement rate pursuant to subdivision (b) of Section 14105.45.(f)A pharmacy provider shall not bill the Medi-Cal program for any prescribed drug that has been automatically filled, regardless of whether that prescribed drug has been dispensed by mail order or retail.(g)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of a provider bulletin or notice, policy letter, or other similar instructions, without taking regulatory action.
Amended IN Assembly March 12, 2020 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2983Introduced by Assembly Member HoldenFebruary 21, 2020An act to amend Section 14105.455 of the Welfare and Institutions Code, relating to Medi-Cal. An act to add Section 4063.5 to the Business and Professions Code, relating to healing arts.LEGISLATIVE COUNSEL'S DIGESTAB 2983, as amended, Holden. Pharmacy provider: billing. Pharmacies: automatic refills.Existing law, the Pharmacy Law, provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy, and makes a willful violation of those provisions a misdemeanor. Existing law prohibits a prescription for any dangerous drug or dangerous device to be refilled except upon authorization of the prescriber.This bill would prohibit a pharmacy from automatically contacting a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a 7-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The bill would require a pharmacy to obtain separate authorization for each prescription and would prohibit a pharmacy from requesting more than the number of refills authorized in the original prescription. Because the bill would expand the scope of 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. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Pursuant to a schedule of benefits, these services include prescription drugs that are subject to the Medi-Cal List of Contract Drugs. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law requires pharmacy providers to submit their usual and customary charge when billing the Medi-Cal program for prescribed drugs, and to keep and maintain records of those charges for a period of 3 years from the date the service was rendered.This bill would prohibit pharmacy providers from billing the Medi-Cal program for any prescribed drug that has been automatically filled, regardless of whether that prescribed drug has been dispensed by mail order or retail.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOYES
Amended IN Assembly March 12, 2020
Amended IN Assembly March 12, 2020
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill
No. 2983
Introduced by Assembly Member HoldenFebruary 21, 2020
Introduced by Assembly Member Holden
February 21, 2020
An act to amend Section 14105.455 of the Welfare and Institutions Code, relating to Medi-Cal. An act to add Section 4063.5 to the Business and Professions Code, relating to healing arts.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2983, as amended, Holden. Pharmacy provider: billing. Pharmacies: automatic refills.
Existing law, the Pharmacy Law, provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy, and makes a willful violation of those provisions a misdemeanor. Existing law prohibits a prescription for any dangerous drug or dangerous device to be refilled except upon authorization of the prescriber.This bill would prohibit a pharmacy from automatically contacting a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a 7-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The bill would require a pharmacy to obtain separate authorization for each prescription and would prohibit a pharmacy from requesting more than the number of refills authorized in the original prescription. Because the bill would expand the scope of 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. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Pursuant to a schedule of benefits, these services include prescription drugs that are subject to the Medi-Cal List of Contract Drugs. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law requires pharmacy providers to submit their usual and customary charge when billing the Medi-Cal program for prescribed drugs, and to keep and maintain records of those charges for a period of 3 years from the date the service was rendered.This bill would prohibit pharmacy providers from billing the Medi-Cal program for any prescribed drug that has been automatically filled, regardless of whether that prescribed drug has been dispensed by mail order or retail.
Existing law, the Pharmacy Law, provides for the licensure and regulation of pharmacists and pharmacies by the California State Board of Pharmacy, and makes a willful violation of those provisions a misdemeanor. Existing law prohibits a prescription for any dangerous drug or dangerous device to be refilled except upon authorization of the prescriber.
This bill would prohibit a pharmacy from automatically contacting a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a 7-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The bill would require a pharmacy to obtain separate authorization for each prescription and would prohibit a pharmacy from requesting more than the number of refills authorized in the original prescription. Because the bill would expand the scope of 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.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. Pursuant to a schedule of benefits, these services include prescription drugs that are subject to the Medi-Cal List of Contract Drugs. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law requires pharmacy providers to submit their usual and customary charge when billing the Medi-Cal program for prescribed drugs, and to keep and maintain records of those charges for a period of 3 years from the date the service was rendered.
This bill would prohibit pharmacy providers from billing the Medi-Cal program for any prescribed drug that has been automatically filled, regardless of whether that prescribed drug has been dispensed by mail order or retail.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 4063.5 is added to the Business and Professions Code, to read:4063.5. A pharmacy shall not automatically contact a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a seven-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The pharmacy shall obtain separate authorization to automatically contact the prescriber for each prescription and shall not request more than the number of refills authorized in the original prescription.SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.SECTION 1.Section 14105.455 of the Welfare and Institutions Code is amended to read:14105.455.(a)A pharmacy provider shall submit their usual and customary charge when billing the Medi-Cal program for any prescribed drug, except as specified in subdivision (f).(b)Usual and customary charge means the lower of the following:(1)The lowest price reimbursed to the pharmacy by a third-party payer in California, excluding any Medi-Cal managed care plan and Medicare Part D prescription drug plan.(2)The lowest price routinely offered to any segment of the general public.(c)Any donation or discount provided to a charitable organization is not considered a usual and customary charge.(d)A pharmacy provider shall keep and maintain records of any usual and customary charge for a period of three years from the date that they rendered the service.(e)Payment to a pharmacy provider shall be the lower of the pharmacys usual and customary charge or the reimbursement rate pursuant to subdivision (b) of Section 14105.45.(f)A pharmacy provider shall not bill the Medi-Cal program for any prescribed drug that has been automatically filled, regardless of whether that prescribed drug has been dispensed by mail order or retail.(g)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of a provider bulletin or notice, policy letter, or other similar instructions, without taking regulatory action.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 4063.5 is added to the Business and Professions Code, to read:4063.5. A pharmacy shall not automatically contact a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a seven-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The pharmacy shall obtain separate authorization to automatically contact the prescriber for each prescription and shall not request more than the number of refills authorized in the original prescription.
SECTION 1. Section 4063.5 is added to the Business and Professions Code, to read:
### SECTION 1.
4063.5. A pharmacy shall not automatically contact a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a seven-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The pharmacy shall obtain separate authorization to automatically contact the prescriber for each prescription and shall not request more than the number of refills authorized in the original prescription.
4063.5. A pharmacy shall not automatically contact a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a seven-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The pharmacy shall obtain separate authorization to automatically contact the prescriber for each prescription and shall not request more than the number of refills authorized in the original prescription.
4063.5. A pharmacy shall not automatically contact a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a seven-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The pharmacy shall obtain separate authorization to automatically contact the prescriber for each prescription and shall not request more than the number of refills authorized in the original prescription.
4063.5. A pharmacy shall not automatically contact a prescriber to authorize a prescription for any dangerous drug or device to be refilled for more than a seven-day supply unless the prescriber or patient has expressly authorized the pharmacy to automatically contact the prescriber to refill that prescription. The pharmacy shall obtain separate authorization to automatically contact the prescriber for each prescription and shall not request more than the number of refills authorized in the original prescription.
SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 2. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
### SEC. 2.
(a)A pharmacy provider shall submit their usual and customary charge when billing the Medi-Cal program for any prescribed drug, except as specified in subdivision (f).
(b)Usual and customary charge means the lower of the following:
(1)The lowest price reimbursed to the pharmacy by a third-party payer in California, excluding any Medi-Cal managed care plan and Medicare Part D prescription drug plan.
(2)The lowest price routinely offered to any segment of the general public.
(c)Any donation or discount provided to a charitable organization is not considered a usual and customary charge.
(d)A pharmacy provider shall keep and maintain records of any usual and customary charge for a period of three years from the date that they rendered the service.
(e)Payment to a pharmacy provider shall be the lower of the pharmacys usual and customary charge or the reimbursement rate pursuant to subdivision (b) of Section 14105.45.
(f)A pharmacy provider shall not bill the Medi-Cal program for any prescribed drug that has been automatically filled, regardless of whether that prescribed drug has been dispensed by mail order or retail.
(g)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section by means of a provider bulletin or notice, policy letter, or other similar instructions, without taking regulatory action.