Health care coverage: prescription hormone therapy and nondiscrimination.

Medi-Cal managed care plans are now explicitly excluded from the prescription hormone therapy coverage requirements. A new subdivision (d) in Section 1367.253 states the section shall not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services under Chapters 7, 8, or 8.75 of Part 3 of Division 9 of the Welfare and Institutions Code. The legislative intent statement was also revised to remove references to Medi-Cal managed care plan contracts.

The coverage mandate now only applies to health care service plan contracts and health insurance policies 'that provides outpatient prescription drug benefits,' rather than applying to all plans unconditionally. This narrows the scope to exclude plans that do not offer outpatient drug coverage.

A new requirement was added to both the Health and Safety Code (Section 1367.253) and Insurance Code (Section 10123.1963): if prescriptions for medically necessary FDA-approved prescription hormone therapy are unavailable within a plan's or insurer's network, the plan or insurer shall arrange for the therapy to be provided by an out-of-network provider.

The definition of 'prescription hormone therapy' was expanded to specify it includes all drugs approved by the FDA as of January 1, 2025, and all drugs approved thereafter. An explicit exclusion was added: glucagon-like peptide-1 or glucagon-like peptide-1 receptor agonists are not included in the definition.

The pharmacy dispensing requirement for a 12-month supply of prescription hormone therapy was moved from an amendment to existing Section 4064.5 (as subdivision g) into a new standalone section, Section 4064.55, of the Business and Professions Code. The substantive requirements remain the same but are now in their own code section.

The specific operative date of 'January 1, 2026' was removed from the coverage provisions and replaced with the generic phrase 'the operative date of this section,' making the effective date dependent on when the urgency clause takes effect rather than a fixed calendar date.

The bill text was reformatted from a formal enrolled legislative document (with page numbers, chapter heading, and passage/receipt blocks) into a web page layout with navigation elements, version history, and bill status metadata. The underlying statutory language in all sections is unchanged.

New Section 1367.253 (Health and Safety Code) requires all health care service plan contracts, including Medi-Cal managed care plans, issued or renewed on or after January 1, 2026, to cover up to a 12-month supply of FDA-approved prescription hormone therapy and necessary self-administration supplies prescribed by a network provider.

New Section 10123.1963 (Insurance Code) imposes the same 12-month supply coverage requirement on health insurance policies issued, amended, renewed, or delivered on or after January 1, 2026.

Coauthors Senator Cervantes and Assembly Member Bonta are added, indicating broader legislative sponsorship for the expanded bill.

Plans and insurers are prohibited from imposing utilization controls or medical management that limit the dispensable supply of prescription hormone therapy to less than 12 months, and cannot require a formal coverage request beyond a pharmacy claim.

Business and Professions Code Section 4064.5 is amended to require pharmacists to dispense up to a 12-month supply of FDA-approved prescription hormone therapy at a patient's request, with exceptions for when the patient requests less, the prescriber instructs a smaller supply, there is an acute dispensing shortage, or the drug is a controlled substance.

'Prescription hormone therapy' is defined as all FDA-approved drugs used to medically suppress, increase, or replace hormones the body is not producing at intended levels, plus necessary supplies for self-administration. The requirement only applies to hormones that can be safely stored at room temperature without refrigeration.

Welfare and Institutions Code Section 14000.01 is amended to require the State Department of Health Care Services to seek federal approval if necessary and issue all-plan letters or similar instructions to implement the hormone therapy coverage for Medi-Cal managed care plans.

The Medi-Cal program is now explicitly named alongside health care service plans and insurers as an entity required to cover a 12-month supply of prescription hormone therapy. The bill also makes prescription hormone therapy a covered benefit under the Medi-Cal program, as specified in a new Welfare and Institutions Code section (14132.04).

The legislative intent statement (Section 1) was expanded to include 'and the Medi-Cal program' in the list of entities required to cover a 12-month supply of prescription hormone therapy and necessary supplies for self-administration.

A sunset provision was added to both Section 1367.253 of the Health and Safety Code and Section 10123.1963 of the Insurance Code, providing that each section shall remain in effect only until January 1, 2035, and is repealed as of that date. The new Welfare and Institutions Code section (14132.04) is similarly subject to repeal.

An urgency clause was added declaring the bill shall take effect immediately rather than on the standard July 1 date following the legislative session. This requires a two-thirds vote of each house for passage, as reflected in the changed vote requirement from 'majority' to 'majority 2/3.'

Section 1 (Health and Safety Code, new Section 1367.0435) now applies only to 'health care service plans' rather than also covering 'health insurers.' Health insurers remain covered under the separate Insurance Code provision in Section 2 of the bill.

New subdivision (f) added to both Section 1 (Health and Safety Code) and Section 2 (Insurance Code) stating that the rights, remedies, and penalties established by the bill are cumulative and do not supersede those under Article 9.5 of the Government Code (Fair Employment and Housing Act), Section 51 of the Civil Code (Unruh Civil Rights Act), or implementing regulations.

The required non-discrimination notice in evidences of coverage was broadened from stating the plan/insurer 'does not discriminate on the basis of sex' to stating it 'does not discriminate on the basis of sex a characteristic protected under applicable state law, including this section,' expanding the scope of the mandatory disclosure.

The prohibition against exclusion now explicitly covers 'enrollment or participation' rather than just 'participation,' making it clearer that insurers and plans cannot deny someone the ability to enroll based on protected characteristics.

Health care service plans must now include in their evidences of coverage, disclosure forms, and combined forms: a statement that they do not discriminate on the basis of sex, instructions on how to file a grievance regarding sex-based discrimination pursuant to Section 1368, the plan's website for filing grievances (if available), and a telephone number for filing grievances.

Health insurers must now include in their evidences of coverage, disclosure forms, and combined forms: a statement that they do not discriminate on the basis of sex, instructions on how to file a grievance regarding sex-based discrimination, the insurer's website for filing grievances (if available), and a telephone number for filing grievances.

New savings clauses added: Section 1367.0435(e) states the section does not limit the director's authority, a health care service plan's duties, or enrollees' rights under that chapter; Section 10133.135(e) states the same for the commissioner's authority, a health insurer's duties, or insureds' rights under that division.

Throughout both code sections, the term 'health services' was changed to 'health care services' for consistency and clarity.