Epilepsy California actively supported two pieces of legislation – AB339 (Gordon. Health care coverage: Outpatient Prescription Drugs.) and AB68 (Waldron. Patient Access to Prescribed Epilepsy Treatments Act). Epilepsy California submitted letters of support throughout the legislative process, kept in constant communication with lead staff assigned to the bill, testified at the Senate Health Committee Hearing in support of AB 68 (EFGLA Staff Member, Rebekkah Halliwell, traveled to Sacramento to do so), and arranged expert counsel and testimony for legislative staff (including the Governor’s office), key stakeholders (such as Department of Health Care Services) and collaborated with other stakeholders.
AB68 was vetoed by the Governor. AB339 would have established that a beneficiary has a right to an urgent appeal (24 hr) process of a MediCal managed care plan’s denial of a drug used in the treatment of seizures and epilepsy and is a drug approved by the federal Food and Drug Administration for the treatment of seizures and epilepsy, as demonstrated by his or her treating physician. The Governor vetoed the legislation on the basis the MediCal currently has an appeal process that addresses the denial of a medication and a law is not warranted. Epilepsy California will continue communication and active participation with the author and MediCal.
AB339 was chaptered into law by the Governor. This law requires health plans and health insurers that provide coverage for outpatient prescription drugs to have formularies that do not discourage the enrollment of individuals with health. This bill places in state law, federal requirements related to pharmacy and therapeutics committees, access to in-network retail pharmacies, standardized formulary requirements, formulary tier requirements similar to those required of health plans and insurers participating in Covered California and copayment caps of $250 and $500 for a supply of up to 30 days for an individual prescription, as specified. As expressed to the author, EFGLA/Epilepsy California agrees that that this is positive step towards making epilepsy medication more accessible, but is ultimately not satisfied with the cost of the copayment caps and believes they are a barrier to making epilepsy medication more affordable. Epilepsy California will continue to identify and be involved in any opportunities and activities that will improve access to medication.
If you’d like to get involved in our advocacy efforts and with Epilepsy California, contact Rebekkah Halliwell at our End Epilepsy office (310.670.2870 or RHalliwell@EndEpilepsy.org) or sign up here.