Companies to submit plans on prescriptions, maximizing telehealth, and ensuring network provider adequacy
March 19, 2020 - OAKLAND, Calif.— On Wednesday, Insurance Commissioner Ricardo Lara and the California Department of Insurance directed health 
insurance companies to submit emergency plans detailing how they will ensure continued access to medically necessary health care services for the duration of the declared COVID‑19 state of emergency. These include allowing for 90-day prescription drug refills, suspending refill waiting periods for all drug tiers, including specialty drugs, and maximizing telehealth to help health insurance policyholders who are sheltered in place. Health insurers are to file their plans with the Department no later than close of business this Friday, March 20th.
The action affects 2 million Californians covered by Department of Insurance-regulated health policies.
“I am ordering health insurance companies to submit their plans to provide consumers access to necessary health care during the state of emergency, including extending prescription refills to a 90-day supply, removing unnecessary barriers to accessing treatment, and taking other steps to protect Californians’ health and safety,” said Insurance Commissioner Ricardo Lara. “With the actions being taken by state and local governments to protect people from coronavirus spread, we are directing health insurance companies to work with us to guarantee access to care for our most vulnerable during these extraordinary times.”
The action exercises the Commissioner’s authority under a 2018 state law that requires health insurance companies to file an emergency plan with the California Department of Insurance. The emergency plan must address:
- How the insurer will remove barriers to access to outpatient prescription drugs, including suspension of prescription fill/refill limitations and refill waiting periods for all drug tiers, including specialty drugs, to allow for policyholders to order a 90-day supply, waiver of charges for home delivery, streamlining/eliminating drug access processes such as step therapy and prior authorization.
- How the insurer is complying with CDI’s March 5, 2020 Bulletin regarding no patient cost-sharing for COVID-19 testing and screening.
- How the insurer will cover medically necessary treatment for COVID-19 infection and related conditions.
- How the insurer will maximize telehealth, including waiving/expediting any network provider credentialing, certification, or pre-authorization requirements, and waive telehealth cost-sharing. This applies to all providers, including but not limited to providers of mental health and substance use disorder services.
- How the insurer will ensure networks provide access to medically appropriate care from a qualified provider, and how the insurer will arrange to provide for available and accessible providers outside the network, with the patient responsible only for in-network cost-sharing, if care cannot be provided within the network.
- How the insurer will communicate with consumers, including maintaining a toll-free telephone number.
- How the insurer will minimize potential disruptions to its operations and facilities located in jurisdictions with shelter-in-place orders, to ensure it can continue to provide consumers access to necessary health care services during the state of emergency.
- Department of Insurance's notice
- The current declared COVID‑19 state of emergency has the “immediate potential to displace insureds” within the meaning of Insurance Code section 10112.95(b). Specifically, the COVID‑19 outbreak has the immediate potential to displace consumers in terms of their ability to access needed medical care, whether through voluntary self-isolation, mandatory shelter-in-place or quarantine orders, or displacement in terms of the ability to access their homes, workplaces, schools, child or dependent care providers, or local communities. For millions of Californians, this potential has already been realized as schools have closed and businesses shuttered as a result of state and local government orders.
- Additional information on Coronavirus (COVID-19)
Source: CA. Dept. of Insurance
