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<ns0:Id>20250AB__091096AMD</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2025-02-19</ns0:ActionDate>
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<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2025-03-24</ns0:ActionDate>
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<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2025-04-10</ns0:ActionDate>
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<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2026-01-22</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:MeasureNum>910</ns0:MeasureNum>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Bonta</ns0:AuthorText>
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<ns0:Name>Bonta</ns0:Name>
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<ns0:Title> An act to amend Sections 1385.0021, 127673.7, and 127674.1 of the Health and Safety Code, relating to pharmacy benefit management.</ns0:Title>
<ns0:RelatingClause>pharmacy benefit management</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Pharmacy benefit management.</ns0:Subject>
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<html:p>Existing law requires a pharmacy benefit manager engaging in business with a health care service plan or health insurer to secure a license from the Department of Managed Health Care on or after January 1, 2027, or the date on which the department has established the licensure process, whichever is later. Existing law requires a complaint about a pharmacy benefit manager to be considered as a complaint against the contracting health care service plan and authorizes it to be considered a complaint against the contracting health insurer.</html:p>
<html:p>Existing law requires the Department of Health Care Access and Information to establish a Health Care Payments Data Program to collect information regarding health care costs, utilization, quality, and equity. Existing law
requires a pharmacy benefit manager to provide specified information to the Department of Health Care Access and Information for inclusion in the program and requires the department to include specified information in an annual analysis. Existing law also requires the Department of Health Care Access and Information to notify the Department of Managed Health Care or the Department of Insurance, as appropriate, if a health care service plan or health insurer fails to comply with specified requirements and requires those departments to take appropriate action.</html:p>
<html:p>This bill would require the Department of Health Care Access and Information to include data regarding pricing and payments related to prescription drugs in its annual analysis upon completion of specified regulations and to notify the Department of Managed Health Care if a pharmacy benefit manager fails to comply with specified requirements, and would require the Department of Managed Health Care to take
appropriate action. The bill would require the Department of Managed Health Care to post on its internet website links to analyses and reporting published by the Department of Health Care Access and Information.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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Section 1385.0021 of the
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is amended to read:
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<ns0:Num>1385.0021.</ns0:Num>
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(a)
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Notwithstanding the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code), the director is not required to disclose any of the following records, or any portion thereof, that are filed by a pharmacy benefit manager with the director in compliance with the requirements of this article, that have not previously been made public:
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<html:p>
(1)
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Corporate financial records, including trade secrets, the information has been confidentially maintained by the business entity, and the release of the information would be damaging or prejudicial to the business concern.
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<html:p>
(2)
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Any application, including an application for an interpretive opinion, including
all records that are submitted with the application that are necessary for purposes of the application.
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<html:p>
(3)
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Any record the disclosure of which is exempt under express provisions of the California Public Records Act, the disclosure of which is exempt or prohibited pursuant to federal or state law, including, but not limited to, provisions of the Evidence Code relating to privilege, or that, on the facts of the particular case, the public interest served by not disclosing the record clearly outweighs the public interest served by disclosure of the record.
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<html:p>
(b)
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Notwithstanding any request for confidentiality of information submitted to and processed by the department consistent with regulations adopted and amended pursuant to this chapter relating to the request for confidentiality of information, the disclosure of records, or any portion thereof, is governed by this section.
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(c)
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Notwithstanding any other provision of this article, the director shall disclose information or records submitted to the director in compliance with this article to the Attorney General, upon request, in order to investigate, prosecute, or defend any legal claim or cause or action related to this article, or to use the reports in any court or proceeding related to this article.
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(d)
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The department shall post on its internet website links to analyses and reporting published by the Department of Health Care Access and Information regarding pharmacy benefit managers pursuant to Sections 127673.7 and 127673.8.
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 127673.7 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:Num>127673.7.</ns0:Num>
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<html:p>The department shall include in an annual analysis, data such as, but not limited to, the following:</html:p>
<html:p>
(a)
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Population and regional level data on prevention, screening, and wellness utilization.
</html:p>
<html:p>
(b)
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Population and regional level data on chronic conditions, management, and outcomes.
</html:p>
<html:p>
(c)
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Population and regional level data on trends in utilization of procedures for treatment of similar conditions to evaluate medical appropriateness.
</html:p>
<html:p>
(d)
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Regional variation in payment level for the treatment
of identified chronic conditions.
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<html:p>
(e)
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Data regarding hospital and nonhospital payments, including inpatient, outpatient, and emergency department payments and nonhospital ambulatory service data.
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<html:p>
(f)
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Upon completion of the regulations promulgated pursuant to Section 127673.05, data regarding pricing and payments related to prescription drugs, including drug pricing, fees paid for pharmacy benefit management services, and payments or rebates to or from pharmacy benefit managers regarding drugs or services.
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<ns0:Num>SEC. 3.</ns0:Num>
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Section 127674.1 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:Num>127674.1.</ns0:Num>
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<html:p>
(a)
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The department shall notify the Department of Managed Health Care or the Department of Insurance, as appropriate, if a health care service plan or health insurer fails to comply with this chapter. The Department of Managed Health Care and the Department of Insurance shall take appropriate action necessary to bring the plan or insurer into compliance.
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(b)
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The department shall notify the Department of Managed Health Care if a pharmacy benefit manager fails to comply with this chapter. The Department of Managed Health Care shall take appropriate action necessary to bring
a pharmacy benefit manager into compliance.
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