California Assembly Bill AB347

California 2021-2022 Regular Session

• Introduced: 1/28/21
• Refer: 2/12/21
• Report Pass: 4/7/21
• Refer: 4/12/21
• Refer: 4/28/21
• Report Pass: 5/20/21
• Engrossed: 6/2/21
• Refer: 6/3/21
• Refer: 6/16/21
• Report Pass: 6/29/21
• Refer: 6/29/21
• Report Pass: 7/12/21
• Refer: 7/13/21
• Refer: 8/16/21
• Report Pass: 8/26/21
• Enrolled: 9/9/21
• Chaptered: 10/9/21
• Passed: 10/9/21

Caption

Health care coverage: step therapy.

Impact

The bill is expected to significantly affect the process through which patients access medications. By requiring plans to grant step therapy exceptions quickly, it aims to streamline medication approval processes for patients who may be adversely affected by a particular medication. It also establishes that if a health care service plan does not respond to a prior authorization request for a step therapy exemption within a specified timeframe, the request will be automatically deemed approved for the duration of the prescribed medication.

Summary

Assembly Bill 347, known as the Health Care Coverage: Step Therapy bill, focuses on the regulation of health care service plans and insurers in California, particularly regarding their ability to utilize step therapy protocols for prescription drugs. The bill clarifies that health care service plans can require step therapy when multiple clinically appropriate drugs are available for a certain medical condition. More importantly, it mandates that health care plans must expeditiously approve requests for exceptions to these protocols based on sufficient justification from healthcare providers.

Sentiment

The sentiment surrounding AB 347 reflects a strong support for patient rights and healthcare provider discretion. Advocates argue that the bill enhances patient care by allowing for individualized treatment plans that consider each patient's unique circumstances and medical history. However, there are concerns among some stakeholders that such regulations may impose additional administrative burdens on health care plans and could be met with pushback from insurance companies aiming to maintain cost controls.

Contention

Notable points of contention include the implications of the mandated approval timelines on insurers' operational procedures and the potential for increased costs associated with more frequent appeals. The bill also does not include financial reimbursements to local agencies for administrative costs incurred due to its implementation. This aspect has drawn criticism from those worried about the financial implications for state and local governments and the potential for exacerbating existing healthcare disparities.