November 2023 Legislative Update

What is new in CRA advocacy:

CRA continues to work with the Department of Managed Health Care (DMHC) on the issue we raised with Anthem no longer paying for injections/infusion on the same day as when billing for an E&M office visit. DMHC has begun conversations with Anthem to better understand their justification for the policy change.

If you are experiencing the same situation with Anthem or any other payers it would be very helpful for you to reach out to Tim Madden (madden@mqadvocacy.com), our advocate in Sacramento, and Shanna Castro, CRA Executive Director (susui@calrheum.org) with details. The more information we can share the greater the chance the DMHC will weigh in on the issue with Anthem.

The Governor finished taking action on bills sent to him in the first year of the two-year session.  He ended up signing 1,170 bills and vetoing 156 bills.

Below are bills CRA is advocated for this year and their outcome.

This bill makes permanent the law capping cost sharing expenses for covered outpatient prescription drugs to $250 per drug for up to a 30-day supply. This law, which has been critical to patients being able to afford their medications, was set to expire at the end of 2023 unless this bill was signed.

The Governor signed this bill.

This bill would create a “gold card” program where if a contracted physician has 90% of their prior authorization requests approved they would be exempt from having to go through prior authorization for the following 12 months. The bill also includes a provision requiring the health plan to use a provider with the same or similar specialty as the treating physician when reviewing an appeal regarding a denial, delay, or modification of a health care service.

Bill was held in the Assembly Appropriations Committee. This bill is dead for this year.

This bill, sponsored by the Crohn’s & Colitis Foundation, requires health plans and insurers to cover denied medications, including the prescribed dose, for the duration of an appeals process. This bill also strengthens California’s prohibition on non-medical switching by applying that same prohibition to a prescribed dose or dose level of a drug.

Bill was held in the Assembly Appropriations Committee. This bill is dead for this year.

This bill would require health plans and health insurers to pass through to enrollees at the time of purchasing prescription drugs at least 90% of all rebates received, or to be received, in connection with the dispensing or administration of the drug being prescribed.

Bill was held in the Assembly Appropriations Committee. This bill is dead for this year.

This is the Medical Board sunset review bill. Once every five years the Legislature reviews each board to look at making any changes. This bill was looking to make a number of changes to the Medical Board.

Two of most interest are:

  • As introduced the bill would have raised physician licensing fees from $863 to $1,350. The reasoning for the increase is the Medical Board is on the verge of financial insolvency and the fee increase is needed to keep the Board from going bankrupt.
    • After extensive negotiations, the fee increase was reduced to $1,151 until 1/1/2027 and after that date the licensing fee will be $1,255.
  • The Medical Board has historically been composed of both physician and non-physician board members. The board has always had a physician majority. This bill adds additional board seats and changes the makeup from a physician majority to a non-physician majority.
    • After lobbying from CRA and other physician groups this provision was dropped from the bill so the Medical Board will continue to have a physician majority.

CRA maintained its’ position of Oppose unless Amended focusing on the large fee increase. We lobbied to limit the fee increase to $150 but given the financial condition of the Medical Board some level of fee increase was needed.

Bill was signed by the Governor.

This bill establishes a $25/hour minimum wage for all healthcare workers. The bill does not apply to physician groups with 25 physicians or less.

Provider and business groups opposed the bill which is being sponsored by SEIU. In August, the Speaker of the Assembly tweeted his support for the bill which led to the hospital association negotiating a deal to soften the blow of the bill. The compromise deal would stagger the minimum wage increase depending on the size and payer mix of the hospital. Most hospitals will be subject to paying a minimum wage of $25/hour by 2026.

This bill was signed by the Governor.

Working with the Hemophilia Council of California, Cystic Fibrosis Research Institute, and the ALS organization. This bill would clarify the law to allow patients to use funds received from any source for the purpose of helping them afford medications to count those funds towards their out-of-pocket requirements. Unfortunately, this bill was not heard in the Assembly Health Committee due to concerns with the Chair of the Committee. The author of the bill is committed to pursuing this issue again in 2024. The bill is eligible to be heard in January of 2024.

  • SB 621 (Caballero)CRA Position: Oppose unless Amended (removed opposition based on amendments described below)

This bill adds biosimilars to the list of medications a plan may require a patient “try and fail” before approving the medication originally prescribed by the treating physician. CRA took an Oppose unless Amended position over concerns the bill would force patients to “try and fail” a biosimilar when they were stable on an existing medication. CRA successfully secured amendments to clarify patients stable on a medication would not be required to “try and fail” a biosimilar. We worked closely with CSRO to obtain this amendment.  The bill passed the Senate after our amendment was placed in the bill.

This bill was signed by the Governor.

We are always looking for patient stories around your challenges with the healthcare system in particular any challenges with the prior authorization process.  If you have any patient stories or are interested in learning more about CRA advocacy efforts, please email Tim Madden at madden@mqadvocacy.com or Shanna Castro at susui@calrheum.org