California 2021-2022 Regular Session Status: Passed Senate 1 D cosponsors

SB 853 — Prescription drug coverage.

Last action — August 11 hearing: Held in committee and under submission.

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed Assembly
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2021-2022 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Summary

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, 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 disability insurers, including health insurers, by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law prohibits a health care service plan contract that covers prescription drug benefits or a specified health insurance policy from limiting or excluding coverage for a drug on the basis that the drug is prescribed for a use that is different from the use for which it was approved by the federal Food and Drug Administration if specified conditions are met. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified. This bill would expand the above-described prohibitions to prohibit limiting or excluding coverage of a drug, dose, or dosage form, and would apply the prohibition to blanket disability insurance policies and certificates. The bill would prohibit a health care service plan or disability insurer that provides coverage for prescription drugs from limiting or declining to cover a drug or dose of a drug as prescribed, or imposing additional cost sharing for covering a drug as prescribed, if specified criteria apply. The bill would provide that a reduction or termination of an ongoing and approved course of treatment before the end of the treatment or the end or amendment of the policy is an adverse benefit determination, and would require a health care service plan or disability insurer to notify an enrollee or insured, or their representative, and the enrollee's or insured's provider in writing of the adverse benefit determination no fewer than 7 calendar days before the effective date. The bill would require a plan or insurer that has approved an ongoing course of treatment to provide continuing coverage pending appeal or review. Because a willful violation of the bill's requirements 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.

Bill Text

Action History

  1. August 11 hearing: Held in committee and under submission.

  2. August 3 set for first hearing. Placed on suspense file.

  3. From committee: Do pass and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (June 28). Re-referred to Com. on APPR.

  4. From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  5. Referred to Com. on HEALTH.

  6. In Assembly. Read first time. Held at Desk.

  7. Read third time. Passed. (Ayes 39. Noes 0. Page 3928.) Ordered to the Assembly.

  8. Ordered to special consent calendar.

  9. Read second time. Ordered to third reading.

  10. From committee: Do pass. (Ayes 7. Noes 0. Page 3771.) (May 19).

  11. Set for hearing May 19.

  12. May 9 hearing: Placed on APPR suspense file.

  13. Set for hearing May 9.

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

  15. From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 10. Noes 0. Page 3461.) (April 20).

  16. Set for hearing April 20.

  17. From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  18. Joint Rule 55 suspended. (Ayes 31. Noes 6. Page 2880.)

  19. (Ayes 31. Noes 6.)

  20. Art. IV. Sec. 8(a) of the Constitution dispensed with.

  21. Referred to Com. on HEALTH.

  22. From printer. May be acted upon on or after February 19.

  23. Introduced. Read first time. To Com. on RLS. for assignment. To print.

Sponsors

Sponsorship breakdown

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1 sponsors · 0 co-sponsors · 121 not signed on

Sponsors (1)

Co-sponsors (0)

None.

Not signed on (121)

121 members have not signed on to this bill.

Show all 121 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Do pass and be re-referred to the Committee on [Appropriations]

Passed 11 Yea · 0 Nay · 4 Other
Party YeaNayPresentNot Voting
Unaffiliated 8003
Democratic 3000
Republican 0001
Total 11004
% of votes cast 73%0%0%27%
How each member voted (15)
Member Party Vote
McCarty — Yea
Nazarian — Yea
Wood — Yea
Mayes — Yea
Santiago — Yea
Rodriguez — Yea
Maienschein — Not Voting
Waldron — Not Voting
Bigelow — Not Voting
Luz Rivas — Yea
Wendy Carrillo — Yea
Aguiar-Curry, Cecilia M. Democratic Yea
Arambula, Joaquin Democratic Yea
Weber Pierson, M.D., Akilah Democratic Yea
Flora, Heath Republican Not Voting

Official roll call →

Special Consent SB853

Passed 39 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Democratic 13000
Unaffiliated 22001
Republican 4000
Total 39001
% of votes cast 98%0%0%3%
How each member voted (40)
Member Party Vote
Portantino — Yea
Atkins — Yea
Leyva — Yea
Pan — Yea
Glazer — Yea
Min — Yea
Hueso — Yea
Dodd — Yea
Bradford — Yea
Bates — Yea
Newman — Yea
Gonzalez — Yea
Roth — Yea
Skinner — Yea
Eggman — Yea
Melendez — Yea
Borgeas — Yea
Kamlager — Yea
Wieckowski — Yea
Wilk — Yea
Rubio — Yea
Nielsen — Yea
Hertzberg — Not Voting
Allen, Benjamin Democratic Yea
Archuleta, Bob Democratic Yea
Becker, Josh Democratic Yea
Caballero, Anna M. Democratic Yea
Cortese, Dave Democratic Yea
Durazo, Maria Elena Democratic Yea
Hurtado, Melissa Democratic Yea
Laird, John Democratic Yea
Limón, Monique Democratic Yea
McGuire, Mike Democratic Yea
Stern, Henry I. Democratic Yea
Umberg, Thomas J. Democratic Yea
Wiener, Scott D. Democratic Yea
Dahle, Megan Republican Yea
Grove, Shannon Republican Yea
Jones, Brian W. Republican Yea
Ochoa Bogh, Rosilicie Republican Yea

Official roll call →

Do pass

Passed 7 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 5000
Republican 1000
Democratic 1000
Total 7000
% of votes cast 100%0%0%0%
How each member voted (7)
Member Party Vote
Portantino — Yea
Kamlager — Yea
Wieckowski — Yea
Bradford — Yea
Bates — Yea
Laird, John Democratic Yea
Jones, Brian W. Republican Yea

Official roll call →

Placed on suspense file

Passed 7 Yea · 0 Nay
Party YeaNayPresentNot Voting
Unaffiliated 5000
Republican 1000
Democratic 1000
Total 7000
% of votes cast 100%0%0%0%
How each member voted (7)
Member Party Vote
Portantino — Yea
Wieckowski — Yea
Kamlager — Yea
Bates — Yea
Bradford — Yea
Laird, John Democratic Yea
Jones, Brian W. Republican Yea

Official roll call →

Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]

Passed 10 Yea · 0 Nay · 1 Other
Party YeaNayPresentNot Voting
Democratic 2001
Unaffiliated 7000
Republican 1000
Total 10001
% of votes cast 91%0%0%9%
How each member voted (11)
Member Party Vote
Pan — Yea
Rubio — Yea
Roth — Yea
Leyva — Yea
Eggman — Yea
Melendez — Yea
Gonzalez — Yea
Hurtado, Melissa Democratic Not Voting
Limón, Monique Democratic Yea
Wiener, Scott D. Democratic Yea
Grove, Shannon Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does SB 853 do?
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, 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 disability insurers, including health insurers, by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law prohibits a health care service plan contract that covers prescription drug benefits or a specified health insurance policy from limiting or excluding coverage for a drug on the basis that the drug is prescribed for a use that is different from the use for which it was approved by the federal Food and Drug Administration if specified conditions are met. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified. This bill would expand the above-described prohibitions to prohibit limiting or excluding coverage of a drug, dose, or dosage form, and would apply the prohibition to blanket disability insurance policies and certificates. The bill would prohibit a health care service plan or disability insurer that provides coverage for prescription drugs from limiting or declining to cover a drug or dose of a drug as prescribed, or imposing additional cost sharing for covering a drug as prescribed, if specified criteria apply. The bill would provide that a reduction or termination of an ongoing and approved course of treatment before the end of the treatment or the end or amendment of the policy is an adverse benefit determination, and would require a health care service plan or disability insurer to notify an enrollee or insured, or their representative, and the enrollee's or insured's provider in writing of the adverse benefit determination no fewer than 7 calendar days before the effective date. The bill would require a plan or insurer that has approved an ongoing course of treatment to provide continuing coverage pending appeal or review. Because a willful violation of the bill's requirements 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.
Who sponsors SB 853?
SB 853 is sponsored by Wiener, Scott D. (Democratic).
What is the current status of SB 853?
This bill died with 2021-2022 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 853?
Track SB 853 free on One Click Politics — get push/email alerts when it moves.

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Last checked for changes 3 months ago · updated continuously

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