Senator Wiener’s Health Care Accountability and Access Legislation to Support Improved Patient Care Pass Senate Health Committee

April 20, 2022

SACRAMENTO - Senator Scott Wiener’s (D-San Francisco) legislation to improve patient access to quality health care, Senate Bill 853 and Senate Bill 858, passed the Senate Health Committee by votes of 10-0 and 8-1 respectively. SB 858 will now head to the Senate Judiciary Committee, and SB 853 will head to the Senate Appropriations Committee. SB 858, the Health Plan Accountability Act, updates and increases penalties for health plans that violate state law in denying or delaying insurance coverage. SB 853, the Medication Access Act, requires health plans to cover medications through the duration of any appeals process of a denial of insurance coverage.

Patient care is of paramount importance in the era of COVID-19, and both pieces of legislation will facilitate better health care for all Californians. 

Health plan premiums have quadrupled in the past 20 years, while fine amounts for health plan violations of the law haven’t changed since 1999. This allows plans to skirt responsibility and withhold care if they deem the fine amount inconsequential or just a cost of doing business. For example, in October 2020, California’s Department of Managed Health Care (DMHC) fined Anthem Blue Cross $1.2 million for not providing gender-affirming care, which is required by state law. Even after they were notified of the fine, they failed to provide these services to enrollees. 

SB 858, the Health Plan Accountability Act, gives the Department of Managed Healthcare the additional authority to levy higher fines and impose corrective action when necessary. This will ensure that penalty amounts increase as health plan premiums increase. It is sponsored by Health Access California.

Additionally, Senator Wiener introduced SB 853, the Medication Access Act, to ensure patients can obtain medications they need during an appeals process after a health plan has denied coverage. Insurance companies can deny coverage of a medication (or a specific dose that a patient has previously been prescribed, or an optimized dose of a previously prescribed medication), and patients have the right to appeal this decision. Currently, for the duration of the external appeals process, patients don’t have access to the medication they need to stay healthy or even alive. The Medication Access Act would ensure that patients aren’t hung out to dry as their appeals are reviewed, allowing them to access critically important medication and avoid a lapse in treatment.

SB 853 does this by requiring plans to cover a drug, dose or dosage form that has been previously prescribed to a patient through the duration of an appeals process. It also prohibits plans from seeking reimbursement if the denial is granted.

In addition, SB 853 strengthens California’s prohibition on non-medical switching, which is when a health plan forces a patient to switch from a prescribed drug to a different drug for non-medical reasons. SB 853 does this by expanding coverage to include the prescribed dose and dosage form of a medication. By expanding this coverage and these protections, SB 853 strengthens patient stability and wellbeing. This bill is sponsored by the Chron’s and Colitis Foundation.

“It’s simple: quality and affordable health care is a human right,” said Senator Scott Wiener. “When insurance companies deny coverage of an important or even life-saving medication, or refuse to comply with state law regarding health care coverage, it’s the patients who lose. We need to reverse this and ensure that patients are given the medication and treatment they need.”