Senator Wiener’s Bills to Expand Access To Mental Healthcare For Youth, HIV Prevention Medication, and Correct Medication Dosage Pass Assembly Health Committee
SACRAMENTO – The Assembly Health Committee passed Senator Scott Wiener’s (D-San Francisco) Senate Bill 339, which improves access to youth mental healthcare and preventative HIV medication, and ensures health plans abide by medical providers’ recommendation of medication dosage.
“Improving access to healthcare is critical to making California more livable and just,” said Senator Wiener. “These bills will throw a lifeline to people struggling with mental health issues, HIV risk, and chronic health conditions. I thank the Committee members for advancing these important measures and look forward to advancing them to the Assembly floor.”
SB 238, The Youth Mental Health Access Act
SB 238 will remove barriers preventing youth from accessing mental healthcare. The measure passed 12-3. The bill heads next to the Assembly Appropriations Committee.
Mental health challenges have exploded among California youth in recent years, but far too many youth are still being unjustly denied mental health coverage by their health plans. When these mental healthcare denials are brought before the state’s independent medical review (IMR) process, they are overturned in 68% of cases as of 2021.
Under current law, parents of children denied care must submit a complaint to the state with the Department of Managed Health Care (DMHC) to access the IMR process. Modeled on an existing Medicare process, SB 238 removes these barriers by automatically placing mental health treatment denials to patients age 26 or younger under review. Instead of allowing children whose parents never initiate the process - whether due to language barriers, health literacy, demanding jobs, or other extenuating circumstances - to fall through the cracks, SB 238 gives all children an equal chance at a process proven to improve access to mental health services.
SB 238 builds on existing mental health laws, like SB 855 (Wiener, 2020), which now require health plans to provide medically necessary mental health treatment. The bill is sponsored by Children Now.
SB 339 expands access to critical preventative HIV medication. The measure passed 13-0 and heads next to the Assembly Business & Professionals Committee.
Despite significant public health advancements, HIV remains a major public health challenge in California, with nearly 4,000 new HIV diagnoses each year. Black and Latino gay and bisexual men, Black cisgender women, transgender women, and youth continue to be the populations most impacted by HIV. PrEP is a preventative drug taken orally or intravenously that reduces the risk of contracting HIV through sexual contact by more than 99%, making it more effective than any other measure to prevent HIV, including condoms; but fewer than 25 percent of those who would benefit from PrEP are using these medications.
SB 339 addresses the unforeseen implementation obstacles of California’s first-in-the-nation effort of SB 159 (Wiener, 2019), which aimed to increase access to PrEP by allowing pharmacists to furnish the medication without a prescription. SB 339 allows pharmacists to prescribe a 90-day supply of PrEP, or an ongoing basis if the patient is ensured follow-up care and testing consistent with CDC guidelines. It also requires health plans to cover costs associated with pharmacist services at their contracted rate when furnishing PrEP, including but not limited to, testing. These measures will remove the most significant reported barriers to making PrEP available without a prescription, and bring California closer to the successful progress in other states.
SB 339 is sponsored by the California Pharmacists Association, Equality California, and the San Francisco AIDS Foundation. Read more about SB 339 here.
SB 70, the Medication Access Act
SB 70 improves access to medication by limiting the circumstances in which a health plan can deny coverage of a patient’s medication for financial, rather than medical reasons. The measure passed 12-3. The bill heads next to the Assembly Appropriations Committee.
Changing a patient’s medication over what their doctor prescribed is an insurance company practice sometimes known as “non-medical switching.” Under the Knox Keene Health Care Service plan act of 1975, non-medical switching is prohibited in California. However, the law does not prohibit switching to a generic drug band, apply to off-label medications, or a change in dose level or dosage form. SB 70 aims to close these loopholes.
The impact of these seemingly minor changes in medication can be serious for thousands of Californians living with chronic illnesses. For example, patients living with conditions like inflammatory bowel disease (IBD) and multiple sclerosis (MS) undergo a painful and time intensive process to find effective treatment, often experimenting with multiple medications and dosages. Their conditions are prone to unexpected flare ups that necessitate changes in dosage. Sometimes they must take a drug orally rather than intravenously to avoid interfering with another treatment, like chemotherapy. When insurance companies disrupt this delicate balance, they cause unnecessary suffering and can put patients in life-threatening situations. Medical treatments should be made between providers and patients, not insurance companies.
SB 70 is sponsored by the Crohn’s & Colitis Foundation.