California law requires insurance companies to maintain adequate networks and to preserve access to vital medications and health care services during states of emergencies
August 21, 2020 - LOS ANGELES, Calif. - Insurance Commissioner Ricardo Lara took action to protect Californians’ access to prescriptions and other health care services during the unprecedented statewide wildfire emergency and in light of reports of mail-order medication delays. Commissioner Lara directed health insurance companies to submit emergency plans to the Department, detailing how they will ensure continued access to needed medical care and prescription medications for those covered under Governor Gavin Newsom’s wildfire and extreme weather state of emergency declaration on August 18, 2020. And, with widespread reports of U.S. Postal Service cuts affecting consumers, the Commissioner issued a Notice reminding insurance companies of their obligation under California law to maintain access to prescription drugs.
The emergency plan directs insurance companies to include steps they have taken to ensure access, including allowing for 90-day prescription drug refills, waiving delivery charges for home delivery of prescription medications, and assuring access to non-network pharmacies without increasing costs onto patients, for those in areas affected by the Governor’s proclaimed wildfire state of emergency. Health insurance companies are to file their plans with the Department of Insurance no later than close of business on Wednesday, August 26, 2020.
“Consumers need extra help to stay safe and healthy during this quadruple threat of extreme heat, wildfire evacuations, postal delays, and the pandemic,” said Commissioner Lara. “With many forced out of their homes by fires and more Californians than ever relying on the U.S. Postal Service for essential medications during the pandemic, insurance companies need to ensure access to these life-changing, life-sustaining and life-saving drugs for patients.”
The 367 wildfires currently burning in California have displaced thousands of residents. Separate data shows that mail-order prescriptions grew 21 percent during the start of the COVID-19 pandemic.
Commissioner Lara directed insurance companies to maintain health access through various measures, including:
- Removing 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;
- Maximizing 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.
- Ensuring networks provide access to medically appropriate care from a qualified provider;
- Arranging 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.
Communicating with consumers, including maintaining a toll-free telephone number.Source: CA. Dept. of Insurance