Health care coverage: dementia.

The bill text was reformatted from the official enrolled document layout (with page numbers, signature lines for Secretary of the Senate, Chief Clerk of the Assembly, and Governor) to a web page rendering that includes navigation elements, a digest key showing Vote: MAJORITY, Appropriation: NO, Fiscal Committee: YES, Local Program: YES, and a version history panel.

Minor typographical variation in Section 3: 'Article XIIIB' in the enrolled version appears as 'Article XIII B' (with a space) in the web version. No legal effect.

Removed the provision that allowed health care service plans and health insurers to avoid covering a specific FDA-approved drug or treatment if another pharmaceutically equivalent product was also approved. Insurers can no longer use this as a basis to deny coverage of one approved product in favor of another.

Broadened the covered condition from 'Alzheimer's disease or other related dementia' to 'Alzheimer's disease or other related dementia, medical conditions affecting memory.' This expands coverage requirements to include additional memory-related conditions beyond Alzheimer's and related dementias.

Section (c) on utilization management was changed from 'This section does not prohibit a health care service plan from applying utilization management' to 'Except as provided in subdivision (b), this section does not prohibit...' This clarifies that prior authorization and other utilization management tools remain available but cannot be used to impose step therapy requirements that subdivision (b) prohibits.

Removed the requirement (in both Health and Safety Code section 1373.15 and Insurance Code section 10123.175) that a health care service plan or health insurer covering nonself-administered FDA-approved Alzheimer's treatments as a medical benefit must also include those treatments under its outpatient prescription drug benefit.

Simplified the exigent circumstance provision in both code sections: removed the requirement to 'maintain an expeditious process by which prescribing providers may obtain authorization' and replaced it with a simpler statement that authorization for a medically necessary FDA-approved Alzheimer's treatment shall be considered an exigent circumstance consistent with the referenced section.

New paragraph (a)(2) in both the Health and Safety Code and Insurance Code sections clarifies that covered medically necessary treatments include those administered through a medical benefit, an outpatient prescription drug benefit (to the extent the plan or policy covers outpatient prescription drugs), or both. This gives insurers flexibility in how they deliver the required coverage.

New paragraph (a)(3) in both sections states that coverage does not require a plan or policy to cover drugs or treatments that are pharmaceutically equivalent drug products if the FDA approves more than one medication or treatment that are pharmaceutically equivalent, unless otherwise required by law. This is a cost-saving carve-out for insurers.

The expeditious authorization process provision now explicitly states that 'memory shall be considered an exigent circumstance' and adds specific statutory cross-references (Section 1367.241 for health care service plans, Section 10123.191 for health insurers). This would trigger faster turnaround times for treatment authorizations under existing exigent circumstance rules.

Coauthors were added: Senators Grayson, Richardson, and Smallwood-Cuevas, and Assembly Members Davies and Schiavo.