An act to amend Section 4425 of the Business and Professions Code, relating to pharmacies.

The people of the State of California do enact as follows:


SECTION 1.
Section 4425 of the Business and Professions Code is amended to read:
4425.
(a) As a condition for the participation of a pharmacy in the Medi-Cal program pursuant to Chapter 7 (commencing with Section 14000) of Division 9 of the Welfare and Institutions Code, the pharmacy, upon presentation of a valid prescription for the patient and the patient’s Medicare
card,
card or evidence of residency in California, such as a state-issued identification card or state-issued motor vehicle driver’s license,
shall charge Medicare beneficiaries
or other patients
a price that does not exceed the Medi-Cal reimbursement rate for prescription medicines, and an amount, as set by the State Department of Health Care Services to cover electronic transmission charges. However, Medicare beneficiaries
or other patients
shall not be allowed to use the Medi-Cal reimbursement rate for over-the-counter medications or compounded prescriptions.
(b) The State Department of Health Care Services shall provide a mechanism to calculate and transmit the price to the pharmacy, but shall not apply the Medi-Cal drug utilization review process for purposes of this section.
(c) The State Department of Health Care Services shall monitor pharmacy participation with the requirements of subdivision (a).
(d) The State Department of Health Care Services shall conduct an outreach program to inform Medicare beneficiaries
and California residents generally,
of their right to participate in the program described in subdivision (a), including, but not limited to, the following:
(1) Including on its Internet Web site the Medi-Cal reimbursement rate for, at minimum, 200 of the most commonly prescribed medicines and updating this information monthly.
(2) Providing a sign to participating pharmacies that the pharmacies shall prominently display at the point of service and at the point of sale, reminding the Medicare beneficiaries
and other eligible patients
to ask that the charge for their prescription be the same amount as the Medi-Cal reimbursement rate and providing the department’s telephone number, e-mail address, and Internet Web site address to access information about the program.
(e) If prescription drugs are added to the scope of benefits available under the federal Medicare
program,
Program,
the Senate Office of Research shall report that fact to the appropriate committees of the Legislature. It is the intent of the Legislature to evaluate the need to continue the implementation of this article
for Medicare beneficiaries
under those circumstances.
(f) This section shall not apply to a prescription that is covered by insurance.
For purposes of this section, “covered by insurance” does not apply to a prescription for a specific medication prescribed for a patient that is not included on the drug formulary maintained by that patient’s health care service plan or health insurer, and for which the patient is prepared to pay cash.
SECTION 1.
Section 4425 of the
Business and Professions Code
is amended to read:
4425.
(a)As a condition for the participation of a pharmacy in the Medi-Cal program pursuant to Chapter 7 (commencing with Section 14000) of Division 9 of the Welfare and Institutions Code, the pharmacy, upon presentation of a valid prescription for the patient and the patient’s Medicare card, shall charge Medicare beneficiaries a price that does not exceed the Medi-Cal reimbursement rate for prescription medicines, and an amount, as set by the State Department of Health Care Services to cover electronic transmission charges. However, Medicare beneficiaries shall not be allowed to use the Medi-Cal reimbursement rate for over-the-counter medications or compounded prescriptions.
(b)The State Department of Health Care Services shall provide a mechanism to calculate and transmit the price to the pharmacy, but shall not apply the Medi-Cal drug utilization review process for purposes of this section.
(c)The State Department of Health Care Services shall monitor pharmacy participation with the requirements of subdivision (a).
(d)The State Department of Health Care Services shall conduct an outreach program to inform Medicare beneficiaries of their right to participate in the program described in subdivision (a), including, but not limited to, the following:
(1)Including on its Internet Web site the Medi-Cal reimbursement rate for, at minimum, 200 of the most commonly prescribed medicines and updating this information monthly.
(2)Providing a sign to participating pharmacies that the pharmacies shall prominently display at the point of service and at the point of sale, reminding the Medicare beneficiaries to ask that the charge for their prescription be the same amount as the Medi-Cal reimbursement rate and providing the department’s telephone number, e-mail address, and Internet Web site address to access information about the program.
(e)If prescription drugs are added to the scope of benefits available under the federal Medicare program, the Senate Office of Research shall report that fact to the appropriate committees of the Legislature. It is the intent of the Legislature to evaluate the need to continue the implementation of this article under those circumstances.
(f)This section shall not apply to a prescription that is covered by insurance.
(g)(1)On or before February 1, 2017, the State Department of Health Care Services shall submit a report to the appropriate policy and fiscal committees of the Legislature on the effectiveness of subdivision (a), with data derived pursuant to subdivisions (b) to (d), inclusive, and other data as the department deems necessary. The department also shall include in the report other options and strategies to achieve the greatest savings on prescription drugs for patients.
(2)A report submitted pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.
(3)The requirement for submitting a report imposed under this subdivision is inoperative on February 1, 2021, pursuant to Section 10231.5 of the Government Code.

Summary: Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid
program
Program
provisions. Existing law requires reimbursement to Medi-Cal pharmacy providers for drugs, as prescribed. As a condition for the participation of a pharmacy in the Medi-Cal program, and subject to specified exceptions, existing law requires the pharmacy, upon presentation of a valid prescription for a patient and the patient’s Medicare card, to charge Medicare beneficiaries a price that does not exceed the Medi-Cal reimbursement rate for prescription medicines and an amount, as set by the department, to cover electronic transmission charges.
Existing law prohibits Medicare beneficiaries from being allowed to use the Medi-Cal reimbursement rate for over-the-counter medications or compound medications. Existing law provides that these provisions do not apply to a prescription that is covered by insurance. Existing law requires the department to conduct an outreach program to inform Medicare beneficiaries of their right to participate in this program.
This bill would
require the State Department of Health Care Services, on or before February 1, 2017, to report to the Legislature on the effectiveness of the Medi-Cal pharmacy procedures described above, as specified, and other options and strategies to achieve the greatest savings on prescription drugs for patients.
expand these provisions to also apply to any patient upon presentation of a valid prescription for the patient and evidence of residency in California. The bill would provide that for purposes of these provisions “covered by insurance” does not apply to a prescription for a specific medication prescribed for a patient that is not included on the drug formulary maintained by that patient’s health care service plan or health insurer, and for which the patient is prepared to pay cash.