AB 369 - An Act to Add Section 1367.243 to the Health and Safety Code, and to Add Section 10123.192 to the Insurance Code, Relating to Health Care Coverage.

Health care coverage: prescription drugs. 2011-2012 Legislature. View bill details
Author(s):
Summary:
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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. Commonly referred to as utilization review, existing law governs the procedures that apply… More
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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. Commonly referred to as utilization review, existing law governs the procedures that apply to every health care service plan and health insurer that prospectively, retrospectively, or concurrently reviews and approves, modifies, delays, or denies, based on medical necessity, requests by providers prior to, retrospectively, or concurrent with, the provision of health care services to enrollees or insureds, as specified.

Existing law also imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, requiring a health care service plan that provides prescription drug benefits to maintain an expeditious process by which prescribing providers, as described, may obtain authorization for a medically necessary nonformulary prescription drug, according to certain procedures. Existing law also requires every health care service plan that provides prescription drug benefits that maintains one or more drug formularies to provide to members of the public, upon request, a copy of the most current list of prescription drugs on the formulary.

This bill would impose specified requirements on health care service plans or health insurers that restrict medications for the treatment of pain pursuant to step therapy or fail first protocol. The bill would authorize the duration of any step therapy or fail first protocol to be determined by the prescribing participating plan provider or prescribing provider, as respectively defined, and would, except under certain conditions, prohibit a health care service plan or health insurer from requiring that a patient try and fail on more than 2 pain medications before allowing the patient access to other pain medication prescribed by the prescribing participating plan provider or prescribing provider, as specified.

Because a willful violation of the bill’s provisions relative to health care service plans 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. Hide
 
Status:
This bill was passed by both houses and vetoed by the Governor. It did not become law
Senate Vote: On Passage

PASSED on August 29, 2012.

voted YES: 23 voted NO: 11
6 voted present/not voting

An Act to Add Section 1367.243 to the Health and Safety Code, and to Add Section 10123.192 to the Insurance Code, Relating to Health Care Coverage.

AB 369 — 2011-2012 Legislature

Summary
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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. Commonly referred to as utilization review, existing law governs the procedures that apply to every health care service plan and health insurer that prospectively, retrospectively, or concurrently reviews and approves, modifies, delays, or denies, based on medical necessity, requests by providers prior to, retrospectively, or concurrent with, the provision of health care services to enrollees or insureds, as specified.

Existing law also imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, requiring a health care service plan that provides prescription drug benefits to maintain an expeditious process by which prescribing providers, as described, may obtain authorization for a medically necessary nonformulary prescription drug, according to certain procedures. Existing law also requires every… More
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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. Commonly referred to as utilization review, existing law governs the procedures that apply to every health care service plan and health insurer that prospectively, retrospectively, or concurrently reviews and approves, modifies, delays, or denies, based on medical necessity, requests by providers prior to, retrospectively, or concurrent with, the provision of health care services to enrollees or insureds, as specified.

Existing law also imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, requiring a health care service plan that provides prescription drug benefits to maintain an expeditious process by which prescribing providers, as described, may obtain authorization for a medically necessary nonformulary prescription drug, according to certain procedures. Existing law also requires every health care service plan that provides prescription drug benefits that maintains one or more drug formularies to provide to members of the public, upon request, a copy of the most current list of prescription drugs on the formulary.

This bill would impose specified requirements on health care service plans or health insurers that restrict medications for the treatment of pain pursuant to step therapy or fail first protocol. The bill would authorize the duration of any step therapy or fail first protocol to be determined by the prescribing participating plan provider or prescribing provider, as respectively defined, and would, except under certain conditions, prohibit a health care service plan or health insurer from requiring that a patient try and fail on more than 2 pain medications before allowing the patient access to other pain medication prescribed by the prescribing participating plan provider or prescribing provider, as specified.

Because a willful violation of the bill’s provisions relative to health care service plans 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. Hide
Learn More
At LegInfo.ca.gov
Title
An Act to Add Section 1367.243 to the Health and Safety Code, and to Add Section 10123.192 to the Insurance Code, Relating to Health Care Coverage.
Author(s)
Jared Huffman
Co-Authors
Subjects
  • Health care coverage: prescription drugs
Major Actions
Introduced2/14/2011
Referred to Committee
Passed Assembly Committee on Health4/26/2011
Passed Assembly Committee on Appropriations1/19/2012
Passed Assembly1/26/2012
Passed Senate Committee on Health6/27/2012
Passed Senate Committee on Appropriations8/06/2012
Passed Senate Committee on Appropriations8/16/2012
Passed Senate8/29/2012
Passed Assembly8/30/2012
Presented to the governor (enrolled)9/13/2012
Vetoed by Governor9/30/2012
Vetoed by Governor9/30/2012
Bill History
Chamber/CommitteeMotionDateResult
select this voteAssembly Committee on HealthDo pass and be re-referred to the Committee on Appropriations.4/26/2011This motion PASSED the Assembly Committee on Health
13 voted YES 5 voted NO 1 voted present/not voting
select this voteAssembly Committee on AppropriationsDo pass.1/19/2012This motion PASSED the Assembly Committee on Appropriations
12 voted YES 5 voted NO 0 voted present/not voting
select this voteAssemblyAB 369 HUFFMAN Assembly Third Reading1/26/2012This bill PASSED the Assembly
48 voted YES 22 voted NO 10 voted present/not voting
select this voteSenate Committee on HealthDo pass as amended, and re-refer to the Committee on Appropriations.6/27/2012This motion PASSED the Senate Committee on Health
5 voted YES 2 voted NO 2 voted present/not voting
select this voteSenate Committee on AppropriationsPlaced on Appropriations Suspense file.8/06/2012This motion PASSED the Senate Committee on Appropriations
7 voted YES 0 voted NO 0 voted present/not voting
select this voteSenate Committee on AppropriationsDo pass.8/16/2012This motion PASSED the Senate Committee on Appropriations
5 voted YES 2 voted NO 0 voted present/not voting
currently selectedSenateAssembly 3rd Reading AB369 Huffman By Price8/29/2012This bill PASSED the Senate
23 voted YES 11 voted NO 6 voted present/not voting
select this voteAssemblyAB 369 HUFFMAN Concurrence in Senate Amendments8/30/2012This bill PASSED the Assembly
60 voted YES 15 voted NO 5 voted present/not voting
ActionDateDescription
Introduced2/14/2011
2/14/2011Read first time. To print.
2/15/2011From printer. May be heard in committee March 17.
3/03/2011Referred to Com. on HEALTH.
select this voteVote4/26/2011Do pass and be re-referred to the Committee on Appropriations.
4/27/2011From committee: Do pass and re-refer to Com. on APPR. (Ayes 13. Noes 5.) (April 26). Re-referred to Com. on APPR.
5/04/2011In committee: Set, first hearing. Referred to APPR. suspense file.
5/27/2011In committee: Hearing postponed by committee.
select this voteVote1/19/2012Do pass.
1/19/2012From committee: Do pass. (Ayes 12. Noes 5.) (January 19).
1/23/2012Read second time. Ordered to third reading.
1/26/2012In Senate. Read first time. To Com. on RLS. for assignment.
1/26/2012Read third time. Passed. Ordered to the Senate. (Ayes 48. Noes 22. Page 3592.)
select this voteAssembly Vote on Passage1/26/2012AB 369 HUFFMAN Assembly Third Reading
2/16/2012Referred to Com. on HEALTH.
5/21/2012From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.
6/20/2012From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.
select this voteVote6/27/2012Do pass as amended, and re-refer to the Committee on Appropriations.
7/02/2012From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 5. Noes 2.) (June 27).
7/03/2012Read second time and amended. Re-referred to Com. on APPR.
8/06/2012In committee: Referred to APPR. suspense file.
select this voteVote8/06/2012Placed on Appropriations Suspense file.
8/16/2012From committee: Do pass. (Ayes 5. Noes 2.) (August 16).
select this voteVote8/16/2012Do pass.
8/20/2012Read second time. Ordered to third reading.
8/24/2012Read third time and amended. Ordered to second reading.
8/27/2012Read second time. Ordered to third reading.
8/29/2012Read third time. Passed. Ordered to the Assembly. (Ayes 23. Noes 11. Page 4975.).
8/29/2012In Assembly. Concurrence in Senate amendments pending. May be considered on or after August 31 pursuant to Assembly Rule 77.
currently selectedSenate Vote on Passage8/29/2012Assembly 3rd Reading AB369 Huffman By Price
8/30/2012Assembly Rule 77 suspended. (Page 6605.) Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 60. Noes 15. Page 6621.).
select this voteAssembly Vote on Passage8/30/2012AB 369 HUFFMAN Concurrence in Senate Amendments
9/13/2012Enrolled and presented to the Governor at 12:15 p.m.
Vetoed9/30/2012Vetoed by Governor.
9/30/2012Consideration of Governor's veto pending.

Average contributions given to Senators from interest groups that…

opposed this bill

39 Organizations Supported and 13 Opposed; See Which Ones

Organizations that took a position on
An Act to Add Section 1367.243 to the Health and Safety Code, and to Add Section 10123.192 to the Insurance Code, Relating to Health Care Coverage.: Assembly 3rd Reading AB369 Huffman By Price

39 organizations supported this bill

American Academy of Pain Medicine
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
American Cancer Society
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
American Chronic Pain Association
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
American GI Forum of California
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
American Society of Anesthesiologists
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Association of Northern California Oncologists
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California Academy of Pain Medicine
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California Academy of Physician Assistants
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California Alliance for Retired Americans
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California Arthritis Foundation Council
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Chronic Care Coalition
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Hepatitis C Task Force
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Medical Association
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California NeuroAlliance
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Neurology Society
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Nurses Association
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Orthopaedic Association
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California Podiatric Medical Association
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Professional Firefighters
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Psychological Association
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Society of Anesthesiologists
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Society of Industrial Medicine and Surgery
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
California Society of Physical Medicine and Rehabilitation
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
Congress of California Seniors
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Disability Rights California
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
For Grace
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Global Healthy Living Foundation
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
International Association of Fire Fighters
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Medical Oncology Association of Southern California
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
National Fibromyalgia & Chronic Pain Association
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
National Multiple Sclerosis Society - California Action Network
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
National Nurses United
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Neuropathy Action Foundation
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
Pharmacists Planning Service
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
Power of Pain Foundation
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Reflex Sympathetic Dystrophy Syndrome Association
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
Southern California Cancer Pain Initiative
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
U.S. Pain Foundation
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
United Cerebral Palsy
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.

13 organizations opposed this bill

America's Health Insurance Plans
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Association of California Life & Health Insurance Companies
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Blue Shield of California
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California Association of Health Plans
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California Chamber of Commerce
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
California Manufacturers & Technology Association
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
CVS Caremark
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Express Scripts
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Health Net
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Medco Health Solutions
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
Molina Healthcare
Assembly Committee on Health (2011, April 21). Assembly Committee Analysis. Retrieved May 6, 2011, from Leg. Info.
National Federation of Independent Business
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.
Southwest California Legislative Council
(2012, August 27). Senate Floor Analysis. Retrieved November 26, 2013, from Leginfo: Bill Analysis.

Need proof?

View citations of support and opposition

Anything missing?

Help your colleagues by suggesting an organization that took a position on this vote.
How do you know they have this position? Please include a link to a newspaper article, organization's website, or other source.
We will use it only to contact you about this form. Your address will never appear on this site.

MapLight editors may add this organization after checking the sources you listed above. Thank you for helping to improve our site.

Cancel
Includes reported contributions to campaigns of Senators in office on day of vote, from interest groups invested in the vote according to MapLight, January 1, 2009 – December 31, 2012.
Contributions data source: FollowTheMoney.org

Contributions by Legislator

Namesort iconPartyDistrict$ From Interest Groups
That Supported
$ From Interest Groups
That Opposed
Vote
Elaine AlquistDCA-13$13,700$5,900
Joel AndersonRCA-36$65,050$52,000
Tom BerryhillRCA-14$49,250$37,500
Sam BlakesleeRCA-15$0$0
Ron CalderonDCA-30$43,950$40,300
Anthony CannellaRCA-12$40,500$39,600
Ellen CorbettDCA-10$44,254$3,000
Lou CorreaDCA-34$62,202$35,585
Kevin De LeonDCA-22$144,982$83,341
Mark DeSaulnierDCA-7$83,724$30,750
Bob DuttonRCA-31$25,700$44,300
Bill EmmersonRCA-37$76,494$51,100
Noreen EvansDCA-2$81,399$5,000
Jean FullerRCA-18$50,325$35,675
Ted GainesRCA-1$23,825$107,900
Loni HancockDCA-9$58,155$8,250
Tom HarmanRCA-35$31,350$37,450
Ed HernandezDCA-24$156,327$126,950
Bob HuffRCA-29$92,248$92,240
Christine KehoeDCA-39$22,500$10,750
Doug La MalfaRCA-4$8,600$13,500
Mark LenoDCA-3$79,549$13,400
Ted LieuDCA-28$217,482$47,050
Carol LiuDCA-21$47,845$16,600
Alan LowenthalDCA-27$0$0
Gloria Negrete McLeodDCA-32$75,500$45,785
Alex PadillaDCA-20$52,900$30,400
Fran PavleyDCA-23$151,450$3,898
Curren PriceDCA-26$76,150$40,950
Michael RubioDCA-16$123,642$55,448
Sharon RunnerRCA-17$14,655$5,150
Joe SimitianDCA-11$18,500$6,150
Darrell SteinbergDCA-6$90,750$52,500
Tony StricklandRCA-19$56,150$71,050
Juan VargasDCA-40$66,300$51,550
Mimi WaltersRCA-33$47,050$78,750
Lois WolkDCA-5$46,416$25,950
Rod WrightDCA-25$65,300$47,174
Mark WylandRCA-38$46,400$25,750
Leland YeeDCA-8$49,220$20,300

Add Data Filters:

Legislator Filters
Legislator Filters
Show All
NamePartyDistrict$ From Interest Groups
That Supported
$ From Interest Groups
That Opposed
Vote
Elaine AlquistDCA-13$13,700$5,900
Joel AndersonRCA-36$65,050$52,000
Tom BerryhillRCA-14$49,250$37,500
Sam BlakesleeRCA-15$0$0
Ron CalderonDCA-30$43,950$40,300
Anthony CannellaRCA-12$40,500$39,600
Ellen CorbettDCA-10$44,254$3,000
Lou CorreaDCA-34$62,202$35,585
Kevin De LeonDCA-22$144,982$83,341
Mark DeSaulnierDCA-7$83,724$30,750
Bob DuttonRCA-31$25,700$44,300
Bill EmmersonRCA-37$76,494$51,100
Noreen EvansDCA-2$81,399$5,000
Jean FullerRCA-18$50,325$35,675
Ted GainesRCA-1$23,825$107,900
Loni HancockDCA-9$58,155$8,250
Tom HarmanRCA-35$31,350$37,450
Ed HernandezDCA-24$156,327$126,950
Bob HuffRCA-29$92,248$92,240
Christine KehoeDCA-39$22,500$10,750
Doug La MalfaRCA-4$8,600$13,500
Mark LenoDCA-3$79,549$13,400
Ted LieuDCA-28$217,482$47,050
Carol LiuDCA-21$47,845$16,600
Alan LowenthalDCA-27$0$0
Gloria Negrete McLeodDCA-32$75,500$45,785
Alex PadillaDCA-20$52,900$30,400
Fran PavleyDCA-23$151,450$3,898
Curren PriceDCA-26$76,150$40,950
Michael RubioDCA-16$123,642$55,448
Sharon RunnerRCA-17$14,655$5,150
Joe SimitianDCA-11$18,500$6,150
Darrell SteinbergDCA-6$90,750$52,500
Tony StricklandRCA-19$56,150$71,050
Juan VargasDCA-40$66,300$51,550
Mimi WaltersRCA-33$47,050$78,750
Lois WolkDCA-5$46,416$25,950
Rod WrightDCA-25$65,300$47,174
Mark WylandRCA-38$46,400$25,750
Leland YeeDCA-8$49,220$20,300

Interest Groups that supported this bill

$ Donated
Police & fire fighters unions and associations$1,108,000
Physicians$436,443
Other physician specialists$302,441
Health worker unions$279,500
Psychiatrists & psychologists$117,675
Other non-physician health practitioners$97,918
Pharmacists$49,600
Health & welfare policy$41,716
Welfare & social work$34,500
Women's issues$24,600
Health, education & human resources$4,500
Nonprofit foundations$2,250
Military$650
Elderly issues & Social Security$0

Interest Groups that opposed this bill

$ Donated
Accident & health insurance$691,265
HMOs$201,905
Drug stores$185,554
Life insurance$155,540
Health care services$127,414
Chambers of commerce$88,900
Manufacturing$48,366
General business associations$0
Small business organizations$0
Loading…
Date Range of Contributions
Enter a custom date range