AB 1880

  • California Assembly Bill
  • 2021-2022 Regular Session
  • Introduced in Assembly
  • Passed Assembly May 26, 2022
  • Senate
  • Governor

Prior authorization and step therapy.

Abstract

Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene) , 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 authorizes a health care service plan or health insurer to require step therapy if there is more than one drug that is appropriate for the treatment of a medical condition, as specified. Existing law requires a health care service plan or health insurer to expeditiously grant a step therapy exception request if the health care provider submits justification and supporting clinical documentation, as specified. Under existing law, if a health care service plan or other related entity fails to notify a prescribing provider of its coverage determination within a prescribed time period after receiving a prior authorization or step therapy exception request, the prior authorization or step therapy exception request is deemed approved for the duration of the prescription. Existing law excepts contracts entered into under specified medical assistance programs from these time limit requirements. Existing law permits a health care provider or prescribing provider to appeal a denial of a step therapy exception request for coverage of a nonformulary drug, a prior authorization request, or a step therapy exception request, consistent with the current utilization management processes of the health care service plan or health insurer. Existing law also permits an enrollee or insured, or the enrollee's or insured's designee or guardian, to appeal a denial of a step therapy exception request for coverage of a nonformulary drug, prior authorization request, or step therapy exception request by filing a grievance under a specified provision. This bill would require health care service plan's or health insurer's utilization management process to ensure that an appeal of a denial of an exception request is reviewed by a clinical peer of the health care provider or prescribing provider, as specified. The bill would define the term "clinical peer" for these purposes. The bill would require health care service plans and health insurers that require step therapy or prior authorization to maintain specified information for at least 10 years, including, but not limited to, the number of exception requests for coverage of a nonformulary drug, step therapy exception requests, and prior authorization requests received by the plan or insurer, and, upon request, to provide the information in a deidentified format to the Department of Managed Health Care or the Insurance Commissioner, as appropriate. Because a violation of certain of the bill's requirements 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.

Bill Sponsors (2)

Votes


Actions


Aug 11, 2022

Senate

Read second time. Ordered to third reading.

Senate

From committee: Do pass. (Ayes 5. Noes 1.) (August 11).

Jun 27, 2022

Senate

In committee: Referred to suspense file.

  • Referral-Committee
suspense file.

Jun 21, 2022

Senate

Read second time and amended. Re-referred to Com. on APPR.

  • Amendment-Passage
  • Reading-1
  • Reading-2
  • Referral-Committee
Com. on APPR.

Jun 20, 2022

Senate

From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 2.) (June 15).

Jun 08, 2022

Senate

Referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

May 27, 2022

Senate

In Senate. Read first time. To Com. on RLS. for assignment.

May 26, 2022

Assembly

Read third time. Passed. Ordered to the Senate. (Ayes 62. Noes 9.)

May 19, 2022

Assembly

From committee: Do pass. (Ayes 13. Noes 2.) (May 19).

Assembly

Read second time. Ordered to third reading.

May 11, 2022

Assembly

In committee: Set, first hearing. Referred to suspense file.

  • Referral-Committee
suspense file.

Apr 20, 2022

Assembly

Re-referred to Com. on APPR.

  • Referral-Committee
Com. on APPR.

Apr 19, 2022

Assembly

Read second time and amended.

Apr 18, 2022

Assembly

From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 13. Noes 0.) (April 5).

Mar 29, 2022

Assembly

Re-referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Mar 28, 2022

Assembly

From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.

Feb 18, 2022

Assembly

Referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Feb 09, 2022

Assembly

From printer. May be heard in committee March 11.

Feb 08, 2022

Assembly

Read first time. To print.

Bill Text

Bill Text Versions Format
AB1880 HTML
02/08/22 - Introduced PDF
03/28/22 - Amended Assembly PDF
04/19/22 - Amended Assembly PDF
06/21/22 - Amended Senate PDF

Related Documents

Document Format
04/01/22- Assembly Health PDF
05/09/22- Assembly Appropriations PDF
05/20/22- ASSEMBLY FLOOR ANALYSIS PDF
06/13/22- Senate Health PDF
06/24/22- Senate Appropriations PDF
08/13/22- Sen. Floor Analyses PDF

Sources

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