Prescription drug coverage: dose adjustments.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Enrolled
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed Assembly
- To Governor
- Became Law
Overview
This bill allows a patient’s doctor to request and receive approval to adjust a prescription drug’s dose or frequency, without needing prior authorization from the insurance company, if certain conditions are met. Specifically, the drug must have previously been approved for coverage, it cannot be an opioid or controlled substance, and the dose hasn’t been adjusted more than twice without approval. The bill also requires supporting evidence from peer-reviewed medical journals for off-label uses of the drug. It excludes Medi-Cal managed care plans from this provision.
Key provisions
- Treating providers can request dose adjustments without prior authorization.
- The drug must have previously been approved for coverage for a chronic condition or cancer treatment.
- The drug cannot be an opioid or a scheduled controlled substance.
- Dose adjustments are limited to a maximum of two without prior authorization.
- Off-label uses require supporting data from peer-reviewed medical journals.
- Medi-Cal managed care plans are excluded from this provision.
- The bill creates a state-mandated local program.
- No reimbursement is required from the state for local agencies or school districts due to the creation of a new crime.
Who is affected
- Patients with prescription drug coverage
- Healthcare providers (treating physicians)
- Health insurance companies
- Health care service plans
Bill text
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Sponsors
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1 on record
Primary sponsor
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