20250SB__102398AMD INTRODUCED 2026-02-10 AMENDED_SENATE 2026-03-16 2025 SB AMD Introduced by Senator Laird (Principal coauthor: Assembly Member Mark González) LEAD_AUTHOR SENATE Laird PRINCIPAL_COAUTHOR ASSEMBLY Mark González

An act to amend

Section 1342.74 of the Health and Safety Code, and to amend

Section 10123.1933 of the Insurance Code, relating to health care coverage. health care coverage Health care coverage: antiretroviral drugs, drug devices, and drug products. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.

Existing law generally prohibits a health care service plan, excluding a Medi-Cal managed care plan, or health insurer from subjecting antiretroviral drugs that are medically necessary for the prevention of HIV/AIDS, including preexposure prophylaxis or postexposure prophylaxis, to prior authorization or step therapy. Under existing law, a health care service plan or health insurer is not required to cover all of the therapeutically equivalent versions of those drugs without prior authorization or step therapy if at least one is covered without prior authorization or step therapy.

This bill would instead prohibit a health care service plan, excluding a Medi-Cal managed care plan, or health insurer from subjecting antiretroviral drugs, drug devices, or drug products that are medically necessary for the prevention of HIV/AIDS to prior authorization or step therapy.

The bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, that covers non-self-administered antiretroviral drugs, drug devices, or drug products that are approved by the United States Food and Drug Administration (FDA) for the prevention of HIV/AIDS as a medical benefit to also include those non-self-administered antiretroviral drugs, drug devices, or drug products as an outpatient prescription drug benefit.

Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Existing law creates the Department of Insurance to regulate the business of insurance.

Existing law makes it a crime for a person engaging in the practice of processing, presenting or negotiating claims for policies of insurance to offer, deliver, receive or accept consideration, as specified, as compensation for the referral or procurement of clients or cases, among others.

Existing law makes it unlawful for an insurance agent or broker to receive financial benefit from an automobile repair facility, or other specified consideration, for referring insureds to the facility for vehicle repairs covered under certain specified insurance policies issued by the agent or broker.</xhtml:p><xhtml:p>This bill would make technical, nonsubstantive changes to these provisions.</xhtml:p>"?> MAJORITY NO YES YES NO NO NO NO NO NO NO The people of the State of California do enact as follows:

SECTION

Section 1342.74 of the Health and Safety Code is amended to read: 1342.74. (a)

(1) Notwithstanding

Section 1342.71, a health care service plan shall not subject antiretroviral drugs, drug devices, or drug products that are medically necessary for the prevention of HIV/AIDS, including preexposure prophylaxis or postexposure prophylaxis, to prior authorization or step therapy, except as provided in paragraph (2).

(2) If the United States Food and Drug Administration (FDA) has approved one or more therapeutic equivalents of a drug, drug device, or drug product for the prevention of HIV/AIDS, this

section does not require a health care service plan to cover all of the therapeutically equivalent versions without prior authorization or step therapy, if at least one therapeutically equivalent version is covered without prior authorization or step therapy. (

b) Notwithstanding any other law, a health care service plan shall not prohibit, or permit a delegated pharmacy benefit manager to prohibit, a pharmacy provider from dispensing preexposure prophylaxis or postexposure prophylaxis. (

c) A health care service plan shall cover preexposure prophylaxis or postexposure prophylaxis that has been furnished by a pharmacist, as authorized in Sections 4052.02 and 4052.03 of the Business and Professions Code, including the pharmacist’s services and related testing ordered by the pharmacist. A health care service plan shall pay or reimburse, consistent with the requirements of this chapter, for the service performed by a pharmacist at an in-network pharmacy or a pharmacist at an out-of-network pharmacy if the health care service plan has an out-of-network pharmacy benefit. (

d) This

section does not require a health care service plan to cover preexposure prophylaxis or postexposure prophylaxis by a pharmacist at an out-of-network pharmacy, unless in the case of a medical emergency or if the health care service plan has an out-of-network pharmacy benefit. (

e) Notwithstanding paragraph (2) of subdivision (f), a health care service plan contract issued, amended, or renewed on or after January 1, 2027, that covers non-self-administered antiretroviral drugs, drug devices, or drug products that are approved by the FDA for the prevention of HIV/AIDS as a medical benefit shall also include those non-self-administered antiretroviral drugs, drug devices, or drug products that are approved by the FDA for the prevention of HIV/AIDS as an outpatient prescription drug benefit. (f)

(1) This

section does not apply to a specialized health care service plan contract that covers only dental, mental health, or vision benefits, or a Medicare supplement contract.

(2) This

section applies regardless of whether or not an antiretroviral drug, drug device, or drug product is self-administered. (e)</xhtml:p>"?>

(3) This

section does not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to

Chapter 7 (commencing with

Section 14000),

Chapter 8 (commencing with

Section 14200), or

Chapter 8.75 (commencing with

Section 14590) of Part of Division of the Welfare and Institutions Code, to the extent that the services described in this

section are excluded from coverage under the contract between the Medi-Cal managed care plans and the State Department of Health Care Services.

SEC.

Section 10123.1933 of the Insurance Code is amended to read: 10123.1933. (a)

(1) Notwithstanding

Section 10123.201, a health insurer shall not subject antiretroviral drugs, drug devices, or drug products that are medically necessary for the prevention of HIV/AIDS, including preexposure prophylaxis or postexposure prophylaxis, to prior authorization or step therapy, except as provided in paragraph (2).

(2) If the United States Food and Drug Administration (FDA) has approved one or more therapeutic equivalents of a drug, drug device, or drug product for the prevention of HIV/AIDS, this

section does not require a health insurer to cover all of the therapeutically equivalent versions without prior authorization or step therapy, if at least one therapeutically equivalent version is covered without prior authorization or step therapy. (

b) Notwithstanding any other law, a health insurer shall not prohibit, or permit a contracted pharmacy benefit manager to prohibit, a pharmacist from dispensing preexposure prophylaxis or postexposure prophylaxis. (

c) A health insurer shall cover preexposure prophylaxis or postexposure prophylaxis that has been furnished by a pharmacist, as authorized in Sections 4052.02 and 4052.03 of the Business and Professions Code, including the pharmacist’s services and related testing ordered by the pharmacist. A health insurer shall pay or reimburse, consistent with the requirements of this chapter, for the service performed by a pharmacist at an in-network pharmacy or a pharmacist at an out-of-network pharmacy if the health insurer has an out-of-network pharmacy benefit. (

d) Notwithstanding paragraph (2) of subdivision (e), a health insurance policy issued, amended, or renewed on or after January 1, 2027, that covers non-self-administered antiretroviral drugs, drug devices, or drug products that are approved by the FDA for the prevention of HIV/AIDS as a medical benefit shall also include those non-self-administered antiretroviral drugs, drug devices, or drug products that are approved by the FDA for the prevention of HIV/AIDS as an outpatient prescription drug benefit. (e)

(1) This

section does not apply to a specialized health insurance policy that covers only dental, mental health, or vision benefits, or a Medicare supplement contract.

(2) This

section applies regardless of whether or not an antiretroviral drug, drug device, or drug product is self-administered. (

f) The department and commissioner may exercise the authority provided by this code and the Administrative Procedure Act (Chapter 3.5 (commencing with

Section 11340),

Chapter 4.5 (commencing with

Section 11400), and

Chapter 5 (commencing with

Section 11500) of Part of Division of Title of the Government Code) to implement and enforce this section. If the commissioner assesses an administrative penalty for a violation, any hearing that is requested by the insurer may be conducted by an administrative law judge of the administrative hearing bureau of the department under the formal procedure of

Chapter 5 (commencing with

Section 11500) of Part of Division of Title of the Government Code. This subdivision does not impair or restrict the commissioner’s authority pursuant to another provision of this code or the Administrative Procedure Act.

SEC. 3. No reimbursement is required by this act pursuant to

Section of

Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of

Section of the Government Code, or changes the definition of a crime within the meaning of

Section of

Article XIII B of the California Constitution. <caml:Num>SECTION 1.</caml:Num><caml:ActionLine action="IS_AMENDED" xlink:href="urn:caml:codes:INS:caml#xpointer(%2Fcaml%3ALawDoc%2Fcaml%3ACode%2Fcaml%3ALawHeading%5B%40type%3D'DIVISION'%20and%20caml%3ANum%3D'1.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'PART'%20and%20caml%3ANum%3D'2.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'CHAPTER'%20and%20caml%3ANum%3D'1.'%5D%2Fcaml%3ALawHeading%5B%40type%3D'ARTICLE'%20and%20caml%3ANum%3D'5.'%5D%2Fcaml%3ALawSection%5Bcaml%3ANum%3D'753.'%5D)" xlink:label="fractionType: LAW_SECTION" xlink:type="locator">Section of the <caml:DocName>Insurance Code</caml:DocName> is amended to read:</caml:ActionLine><caml:Fragment><caml:LawSection id="id_E9CA0A80-4986-4888-AA57-C1EDBDD59C42"><caml:Num>753.</caml:Num><caml:LawSectionVersion id="id_344A7D7D-1A7F-45DA-8B66-37B8A39953D3"><caml:Content><xhtml:p>(a)<xhtml:span class="EnSpace"/>It is unlawful for an insurance agent or broker, or an insurance solicitor employed thereby, to receive a financial benefit from an automobile repair facility or other form of direct or indirect consideration from a person for referring insureds to that person or that person’s designee for vehicle repairs covered under the automobile comprehensive coverage, property damage coverage, or automobile collision coverage, of an insurance policy issued through the insurance agent or broker or by an insurer represented by the insurance agent.</xhtml:p><xhtml:p>(b)<xhtml:span class="EnSpace"/>Subdivision (

a) applies with respect to commercial and noncommercial policies of automobile insurance.</xhtml:p><xhtml:p>(c)<xhtml:span class="EnSpace"/>For purposes of this section, “financial benefit” means the receiving of a commission or gratuity, discount on repair costs, free repairs, or employment by a repair facility.</xhtml:p></caml:Content></caml:LawSectionVersion></caml:LawSection></caml:Fragment></caml:BillSection>"?>