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California Assembly Bill AB2169

California 2023-2024 Regular Session

California Assembly Bill AB2169 Compare Versions

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1-Amended IN Assembly March 21, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2169Introduced by Assembly Member Bauer-Kahan(Coauthor: Senator Wiener)February 07, 2024An act to add Section 1367.225 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTAB 2169, as amended, Bauer-Kahan. Prescription drug coverage: dose adjustments.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 the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified.The bill would authorize a licensed health care professional to request, and would require that they be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee or insured without prior authorization if specified conditions are met. Under the bill, if the enrollee or insured has been continuously using a prescription drug selected by their prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan or health insurance policy would be prohibited from limiting or excluding coverage of that prescription. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. 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.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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.225 is added to the Health and Safety Code, to read:1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (C) The dose has not been adjusted more than two times without prior authorization.(2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or 14000), Chapter 8 (commencing with Section 14200) 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. Code.SEC. 2. Section 10123.1934 is added to the Insurance Code, to read:10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(3) The dose has not been adjusted more than two times without prior authorization.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.SEC. 3. 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.
1+CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2169Introduced by Assembly Member Bauer-Kahan(Coauthor: Senator Wiener)February 07, 2024 An act to add Section 1367.225 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 2169, as introduced, Bauer-Kahan. Prescription drug coverage: dose adjustments. 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 the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified.The bill would authorize a licensed health care professional to request, and would require that they be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee or insured without prior authorization if specified conditions are met. Under the bill, if the enrollee or insured has been continuously using a prescription drug selected by their prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan or health insurance policy would be prohibited from limiting or excluding coverage of that prescription. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. 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.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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1367.225 is added to the Health and Safety Code, to read:1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. SEC. 2. Section 10123.1934 is added to the Insurance Code, to read:10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.SEC. 3. 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.
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3- Amended IN Assembly March 21, 2024 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2169Introduced by Assembly Member Bauer-Kahan(Coauthor: Senator Wiener)February 07, 2024An act to add Section 1367.225 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTAB 2169, as amended, Bauer-Kahan. Prescription drug coverage: dose adjustments.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 the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified.The bill would authorize a licensed health care professional to request, and would require that they be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee or insured without prior authorization if specified conditions are met. Under the bill, if the enrollee or insured has been continuously using a prescription drug selected by their prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan or health insurance policy would be prohibited from limiting or excluding coverage of that prescription. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. 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.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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
3+ CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 2169Introduced by Assembly Member Bauer-Kahan(Coauthor: Senator Wiener)February 07, 2024 An act to add Section 1367.225 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 2169, as introduced, Bauer-Kahan. Prescription drug coverage: dose adjustments. 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 the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified.The bill would authorize a licensed health care professional to request, and would require that they be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee or insured without prior authorization if specified conditions are met. Under the bill, if the enrollee or insured has been continuously using a prescription drug selected by their prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan or health insurance policy would be prohibited from limiting or excluding coverage of that prescription. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. 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.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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
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5- Amended IN Assembly March 21, 2024
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7-Amended IN Assembly March 21, 2024
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7+
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99 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION
1010
1111 Assembly Bill
1212
1313 No. 2169
1414
1515 Introduced by Assembly Member Bauer-Kahan(Coauthor: Senator Wiener)February 07, 2024
1616
1717 Introduced by Assembly Member Bauer-Kahan(Coauthor: Senator Wiener)
1818 February 07, 2024
1919
2020 An act to add Section 1367.225 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage.
2121
2222 LEGISLATIVE COUNSEL'S DIGEST
2323
2424 ## LEGISLATIVE COUNSEL'S DIGEST
2525
26-AB 2169, as amended, Bauer-Kahan. Prescription drug coverage: dose adjustments.
26+AB 2169, as introduced, Bauer-Kahan. Prescription drug coverage: dose adjustments.
2727
2828 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 the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified.The bill would authorize a licensed health care professional to request, and would require that they be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee or insured without prior authorization if specified conditions are met. Under the bill, if the enrollee or insured has been continuously using a prescription drug selected by their prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan or health insurance policy would be prohibited from limiting or excluding coverage of that prescription. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. 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.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.
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3030 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 the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified.
3131
3232 The bill would authorize a licensed health care professional to request, and would require that they be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee or insured without prior authorization if specified conditions are met. Under the bill, if the enrollee or insured has been continuously using a prescription drug selected by their prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan or health insurance policy would be prohibited from limiting or excluding coverage of that prescription. With respect to health care service plans, the bill would specify that its provisions do not apply to Medi-Cal managed care plan contracts. 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.
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3434 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.
3535
3636 This bill would provide that no reimbursement is required by this act for a specified reason.
3737
3838 ## Digest Key
3939
4040 ## Bill Text
4141
42-The people of the State of California do enact as follows:SECTION 1. Section 1367.225 is added to the Health and Safety Code, to read:1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (C) The dose has not been adjusted more than two times without prior authorization.(2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or 14000), Chapter 8 (commencing with Section 14200) 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. Code.SEC. 2. Section 10123.1934 is added to the Insurance Code, to read:10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(3) The dose has not been adjusted more than two times without prior authorization.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.SEC. 3. 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.
42+The people of the State of California do enact as follows:SECTION 1. Section 1367.225 is added to the Health and Safety Code, to read:1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. SEC. 2. Section 10123.1934 is added to the Insurance Code, to read:10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.SEC. 3. 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.
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4444 The people of the State of California do enact as follows:
4545
4646 ## The people of the State of California do enact as follows:
4747
48-SECTION 1. Section 1367.225 is added to the Health and Safety Code, to read:1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (C) The dose has not been adjusted more than two times without prior authorization.(2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or 14000), Chapter 8 (commencing with Section 14200) 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. Code.
48+SECTION 1. Section 1367.225 is added to the Health and Safety Code, to read:1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services.
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5050 SECTION 1. Section 1367.225 is added to the Health and Safety Code, to read:
5151
5252 ### SECTION 1.
5353
54-1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (C) The dose has not been adjusted more than two times without prior authorization.(2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or 14000), Chapter 8 (commencing with Section 14200) 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. Code.
54+1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services.
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56-1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (C) The dose has not been adjusted more than two times without prior authorization.(2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or 14000), Chapter 8 (commencing with Section 14200) 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. Code.
56+1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services.
5757
58-1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (C) The dose has not been adjusted more than two times without prior authorization.(2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or 14000), Chapter 8 (commencing with Section 14200) 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. Code.
58+1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met: (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment. (B) The drug is not an opioid or a scheduled controlled substance. (2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription. (b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services.
5959
6060
6161
6262 1367.225. (a) (1) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee without prior authorization or subsequent utilization management if the following conditions are met:
6363
6464 (A) The drug previously had been approved for coverage by the plan for an enrollees chronic medical condition or cancer treatment and the plans prescribing provider continues to prescribe the drug for the enrollees chronic medical condition or cancer treatment.
6565
6666 (B) The drug is not an opioid or a scheduled controlled substance.
6767
68-(C) The dose has not been adjusted more than two times without prior authorization.
69-
7068 (2) If the enrollee has been continuously using a prescription drug selected by the enrollees prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the health care service plan shall not limit or exclude coverage of that prescription.
7169
72-(b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or 14000), Chapter 8 (commencing with Section 14200) 14200), or Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services. Code.
70+(b) This section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) or Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plan and the State Department of Health Care Services.
7371
74-SEC. 2. Section 10123.1934 is added to the Insurance Code, to read:10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(3) The dose has not been adjusted more than two times without prior authorization.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
72+SEC. 2. Section 10123.1934 is added to the Insurance Code, to read:10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
7573
7674 SEC. 2. Section 10123.1934 is added to the Insurance Code, to read:
7775
7876 ### SEC. 2.
7977
80-10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(3) The dose has not been adjusted more than two times without prior authorization.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
78+10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
8179
82-10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(3) The dose has not been adjusted more than two times without prior authorization.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
80+10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
8381
84-10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(3) The dose has not been adjusted more than two times without prior authorization.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
82+10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:(1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.(2) The drug is not an opioid or a scheduled controlled substance.(b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
8583
8684
8785
8886 10123.1934. (a) A licensed health care professional may request, and shall be granted, the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the insured without prior authorization or subsequent utilization management if the following conditions are met:
8987
9088 (1) The drug previously had been approved for coverage by the insurer for an insureds chronic medical condition or cancer treatment and the insurers prescribing provider continues to prescribe the drug for the insureds chronic medical condition or cancer treatment.
9189
9290 (2) The drug is not an opioid or a scheduled controlled substance.
93-
94-(3) The dose has not been adjusted more than two times without prior authorization.
9591
9692 (b) If the insured has been continuously using a prescription drug selected by the insureds prescribing provider for the medical condition under consideration while covered by their current or previous health coverage, the insurer shall not limit or exclude coverage of that prescription.
9793
9894 SEC. 3. 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.
9995
10096 SEC. 3. 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.
10197
10298 SEC. 3. 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.
10399
104100 ### SEC. 3.