On October 7, 2023, California Governor Gavin Newsom signed Senate Bill 786 (SB 786) into law, prohibiting pharmacy benefit managers (PBMs) from discriminating against covered entities participating in the 340B Program. Effective January 1, 2024, PBMs cannot impose requirements, conditions or exclusions that discriminate or prevent a 340B covered entity from obtaining and retaining the benefit of the discounted drugs available through the 340B Program. The law applies to any entity that meets the California definition of a PBM, including wholly and partially owned and controlled entities of a PBM and PBMs that contract with Medicare or Medi-Cal managed care organizations.

A bill seeking to address understaffing and medication errors in chain pharmacies in California is now headed to Gov. Gavin Newsom's desk. State lawmakers have recently passed Assembly Bill 1286 or the Stop Dangerous Pharmacies Act after months of negotiations with chain pharmacies, labor groups and regulators, bill proponent Assembly member Matt Haney, D-San Francisco, announced.

AB 1286 creates first-in-the-nation regulations to crack down on understaffed chain pharmacies making medication errors, Haney's office said. They added that if the bill is signed into law, California will become "a national leader in pharmacy safety."

The proposed law requires corporate chain pharmacies to report all medication errors as well as provide baseline pharmacy staffing rules to ensure that California pharmacists are receiving the support they need as they fill prescriptions, and give injections.

Los Angeles County has become the latest local government to accuse pharmacy benefit managers — the little-known middlemen of the prescription drug industry — of stoking the opioid crisis by helping flood the nation with highly addictive pills. In a lawsuit filed last week in Los Angeles County Superior Court, the county alleged that Express Scripts Inc. and OptumRx Inc. colluded with drug manufacturers to promote dangerously addictive opioids as a safe and moderate pain treatment option. Instead of advocating for the lowest price, the county alleges, the companies used “deceptive, dangerous marketing” to push dangerous drugs they knew would earn them a lucrative profit. Counties in Ohio, Texas and Virginia have all filed similar suits to L.A. County’s, alleging that a small handful of pharmacy benefit managers turned a blind eye to obvious signs of addiction and drug abuse.

Blue Shield of California has announced its intentions to stop using most of CVS Health's PBM services by early 2025 and open their doors to others including Amazon.com’s struggling pharmacy dispensing service and entrepreneur Mark Cuban's firm Cost Plus Drugs. As reported by Reuters, “The regional health insurance provider will still retain CVS Caremark for managing specialty drugs, costly medications used to treat complex conditions like cancer and rheumatoid arthritis,” and in the move, Blue Shield anticipates saving $500 million annually in drug costs. Blue Shield serves nearly 5 million Americans. “This is a huge development for our industry. It disintermediates a mega-PBM but unfortunately, it could be a model relying on mail order pharmacy from Amazon for generics and mail order specialty prescriptions from CVS-Aetna,” says NCPA’s CEO Douglas Hoey.

Walgreens has agreed to pay $230 million to San Francisco for its role in the city’s opioid epidemic following last year’s landmark trial that found the pharmacy chain liable for not performing proper screenings. The case was the first of its kind in the region and the first to include defendants along the pharmaceutical supply chain, including drug manufacturing, distributors and pharmacies. A federal judge found Walgreens liable for “substantially contributing to the opioid epidemic in San Francisco." From 2006 to 2014, San Francisco County saw 163,645,704 opioids distributed, enough for 22 pills per person per year, according to the city attorney’s office.

The California State Assembly Committee on Health is considering a new bill, Assembly Bill 317. AB 317 mandates that health plans that offer coverage for a service within the pharmacists’ scope of practice pay or reimburse the cost of services performed by a pharmacist at an in-network pharmacy or by a pharmacist at an out-of-network pharmacy if the health plan or insurer has an out-of-network pharmacy benefit. AB 317 ensures patients can receive vital health care services provided by their pharmacist.

Recently-introduced legislation to reform PBMs, AB 913, has been referred to the California Committee on Business and Profession. In addition to creating a PBM licensure program under the Board of Pharmacy, the bill prohibits retroactive fees, gag clauses, discrimination against non-affiliated pharmacies, patient steering, and spread pricing. AB 913 also empowers the Board of Pharmacy to issue fines for licensure violations and to audit PBMs for noncompliance. Organizations like NCPA strongly support the legislation and is actively engaged on the ground and in coalition efforts.

A new California bill would protect health care providers who mail abortion pills to patients in other states where the medication may be illegal. The bill, announced in the state legislature on Friday, would only apply to California doctors. It also allows health care providers to bring suit "against anyone who interferes with the health care provider’s right to provide care that is legal in California," per state Sen. Nancy Skinner (D). "[The bill] will further protect our health care providers who are extending a lifeline to their patients who may be in a state where medically safe and effective treatments are now illegal," Skinner said. Skinner's bill also includes protections for doctors who mail services for contraception or gender-affirming care.

Centene Corp. has reached a $215.4 million settlement with California to resolve accusations it overcharged a state program for affordable healthcare by falsely inflating its costs for providing prescription drugs to patients. State investigators said that in 2017 and 2018 Centene took advantage of its pharmacy benefit manager contracts to save two of its managed care plans, California Health & Wellness and Health Net, $2.70 per prescription drug claim. The St. Louis-based company then failed to pass on these savings to California's Medi-Cal program, inflating its costs, the investigators found. Both acts violated California's False Claims Act, leading to the lawsuit and, now, settlement.

The state of California announced it will sue the companies that make and promote most of the nation's insulin, accusing them of scheming to illegally increase the price of the drug and demanding they return millions of dollars to some diabetics who state officials say were overcharged for the medicine they must have to survive. The lawsuit, to be filed in Los Angeles County Superior Court by Attorney General Rob Bonta, is the latest in a parade of legal actions against these companies from states across the political spectrum — all who have accused the corporate giants of abusing their power to quash competition and boost their profits by keeping the price of insulin high.

On August 10, a federal judge ruled that Walgreens can be held responsible for contributing to San Francisco’s opioid crisis. The decision comes after Walgreens dispensed highly addictive drugs for years without proper oversight and failed to identify and report suspicious orders, as required by California state law. The San Francisco city attorney says that San Francisco saw a nearly 500 percent increase in opioid-related overdose deaths between 2015 and 2020, for which Walgreens is held liable. The August 10 ruling did not include a ruling on monetary damages, which will be determined in a future trial. Walgreens also faces litigation in Alabama, Michigan, and New Mexico.

More than 600 pharmacists at Ralphs, Vons, Albertsons, and Pavilions stores in Southern California could walk out following an “overwhelming” membership vote to authorize union leadership to call for a strike. The pharmacists in question claim the chains have engaged in “unlawful and unfair treatment,” including retaliating against pharmacists who engage in union activity, attempting to bribe pharmacists with bonuses instead of negotiating wage increases, and hiring temporary workers to undermine union activity. No dates have been set for a strike and negotiations with the chains continue.

On July 7, 2022, California Gov. Gavin Newsom announced that the most recent state budget, signed last week, includes a $100 million allotment for California to “contract to make [its] own insulin at a cheaper price, close to at cost.”  The budget designates $50 million to develop biosimilar insulin products and the remaining $50 million to build an insulin manufacturing facility in California. The decision is part of California’s initiative to create its own prescription drugs, which began in 2019. Manufactured prescription drugs, including insulin, will be sent out to retail pharmacies around the state.

Also included in Gov. Gavin Newsom’s July 7 budget was a provision that forgives $142 million in Medi-Cal clawbacks from independent pharmacies in the state. The clawbacks came from California’s retroactive adoption of NADAC in its Medicaid program and would have had devastating impacts on pharmacies across the state. With clawbacks now forgiven, California pharmacists can continue to serve patients without the additional financial burden.

A new California bill could tighten regulations on controlled substances and help prevent substance abuse. AB 2265 was introduced by California Assembly Member Dr. Joaquin Arambula (D-Fresno) on February 16, 2022. AB 2265 would require pharmacists to dispense Schedule II or Schedule IIN controlled substances in a lockable vial, as well as provide a specified opioid factsheet to patients upon dispensing. In addition, it would require the manufacturer of the controlled substance to reimburse the pharmacy for the cost of the lockable vial within 30 days. AB 2265 is expected to be heard in committee on March 19, 2022.

This article summarizes three recently passed laws related to the practice of pharmacy in the state of California. SB 362 prohibits performance "quotas" implemented by community pharmacies, AB 1064 authorizes pharmacists to independently administer any approved vaccine to those ages 3 and older, and SB 409 gives authorization to pharmacists to perform certain approved CLIA-waived point-of-care tests. Click the link to learn more about this new legislation.

California Governor Gavin Newsom has signed AB 1533 into law. This bill has been supported and advocated for by the California Pharmacists Association (CPhA) in order to implement new changes to pharmacy law, including an expansion of authority for pharmacists. This new law allows pharmacists to provide any medication-assisted treatment as long as it is authorized by federal law, requires representation by a compounding pharmacist on the state Board of Pharmacy professional team, and also addresses violations of pharmacy law committed by chain pharmacies.

California Assembly Bill 2789 was passed into law in 2018 with a 3-year delay in implementation. Now, the California Medical Association is reminding health care practitioners that beginning this January 1, 2022, almost all prescriptions being written in the state of California must be done so electronically. There are a few exceptions to this rule that are listed in the article linked below.

As of Friday September 3rd, SB 524, an anti-steering bill, has passed California legislature and awaits Governor Newsom's signature. NCPA has written a letter to urge the Governor's approval for this bill that would protect patient access to local pharmacy services and give them the freedom and authority to make their own healthcare decisions. The bill would help prevent unfair PBM and insurer practices by prohibiting them from steering patients to their own PBM and insurer-owned pharmacies.

AB 133 has been signed by Governor Newsom, and this law now extends Medi-Cal eligibility to undocumented Californians age 50 and older. It also requires the Department of Health Care Services to implement a medication therapy management (MTM) benefit and reimbursement methodology for all covered pharmacist services that are related to the dispensing of all qualified specialty drugs.

The California Board of Pharmacy recently passed new limitations on prescription refill programs at pharmacies across the state, which go into effect on July 1, 2022. These new limitations are designed to give pharmacists greater oversight in patient medication usage and minimize prescription drug abuse.

Attorney General Rob Bonta joined a bipartians coalition of 34 attorneys general across the country to file an amicus brief supporting the regulation of pharmacy benefit managers (PBMs). Attorney General Bonta's decision comes in an effort to help curb abuses by the multi-billion-dollar industry, which harm California patients.

The state's "No Pharmacist Left Alone" law (SB 1442) ensures that pharmacists don't work alone in a pharmacy, after concerns were raised about understaffing at community pharmacies. New additions to the law mandate that another employee must work alongside the pharmacist to complete certain designated tasks.