Prescription drug cost sharing.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Appropriations
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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 aims to change how health insurance plans and insurers calculate out-of-pocket costs for prescription drugs. It requires plans and insurers to include any financial assistance provided by drug manufacturers – like discounts or rebates – when determining an enrollee’s or insured’s cost-sharing obligations. The bill also establishes a penalty for non-compliance and clarifies certain definitions related to cost-sharing and drug types.
Key provisions
- Requires health care service plans and health insurers to include drug manufacturer assistance in cost-sharing calculations.
- Establishes an administrative penalty for health insurers that violate the bill’s provisions.
- Defines key terms related to cost-sharing, such as ‘essential health benefits’ and ‘biosimilar’.
- Specifies that certain types of generic or interchangeable drugs are exempt from cost-sharing requirements.
- Addresses health savings account eligibility when applying cost-sharing rules.
- Creates a new infraction for violations of the bill.
- Provides for an administrative penalty for violations.
Who is affected
- Health insurance enrollees
- Health care service plans
- Health insurers
- Drug manufacturers
- California residents
Notable changes
- Expands the definition of ‘cost sharing’ to include drug manufacturer assistance.
Bill text
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Sponsors
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1 on record
Primary sponsor
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