AB 68: Medi-Cal.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Covered benefits under the Medi-Cal program include the purchase of prescribed drugs, subject to the Medi-Cal List of Contract Drugs and utilization controls.

This bill, which would be known as the Patient Access to Prescribed Epilepsy Treatments Act, would subject, to the extent permitted by federal law, the denial of coverage by a Medi-Cal managed care plan of any drug in the seizure or epilepsy therapeutic drug class prescribed by a Medi-Cal beneficiarys treating provider to an urgent appeal process, as specified, if the treating provider demonstrates that in his or her reasonable, professional judgment, the drug is medically necessary and consistent with specified federal rules and regulations, and the drug is not on the Medi-Cal managed care plan formulary.