Senator Wiener’s Prescription Drug Access Legislation Passes Senate

SACRAMENTO - Today, Senator Scott Wiener’s (D-San Francisco) legislation to improve patient access to prescription medication, Senate Bill 853, passed the Senate in a bipartisan, unanimous vote. It will now head to the Assembly for policy committee hearings. SB 853, the Medication Access Act, requires health plans to cover medications through the duration of an external appeals process of a coverage denial and strengthens California’s prohibition on non-medical switching, when a health plans forces a patient to switch drugs for non-medical reasons – to include medication dose or dosage form in the definition.

SB 853 will improve medication access in two major ways:

1. It requires plans to cover a patient’s previously prescribed drug, dose or dosage form through the duration of an appeals process in the event that their health plan denies coverage. This will ensure patients can get the medications they need during an appeals process. 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. The Medication Access Act ensures 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. It also prohibits plans from seeking reimbursement if the denial is granted.
2. It 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 ensures that if a patient is prescribed a different dose or dosage form of a drug they are already taking, their health plan must continue to cover this medication.  By expanding this coverage and these protections, SB 853 strengthens patient stability and well-being.

SB 853 is sponsored by the Crohn’s and Colitis Foundation.

“Californians should never be denied access to life-saving medicine,” said Senator Wiener. “Even a short interruption can have extremely damaging and potentially fatal impacts. Particularly for people with chronic illnesses, battling with insurance companies about prescription drug coverage can feel like a full-time job. It shouldn’t have to be this way, and SB 853 will help patients get the medications they need.”