Healthcare

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 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, the Protecting Rights, Expanding Prevention, and Advancing Reimbursement for Equity (PrEPARE) Act of 2025, 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, but would authorize prior authorization or step therapy if at least one therapeutically equivalent version is covered without prior authorization or step therapy. The bill would specify that, for therapeutically equivalent coverage purposes, a long-acting drug, drug device, or drug product is not therapeutically equivalent to a long-acting drug, drug device, or drug product with a different duration. The bill would require a plan or insurer 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. This bill would require a nongrandfathered health care service plan contract or health insurance policy to provide coverage for antiretroviral drugs, drug devices, or drug products that are approved by the FDA for HIV preexposure prophylaxis, and would prohibit a nongrandfathered health care service plan contract or health insurance policy from imposing any cost sharing for those drugs, drug devices, or drug products. The bill would prohibit a plan or insurer from imposing cost sharing on a nonformulary antiretroviral drug, drug device, or drug product that is approved by the FDA for HIV preexposure prophylaxis and is covered pursuant to an exception request if the nonformulary antiretroviral drug, drug device, or drug product is therapeutically equivalent to a formulary antiretroviral drug, drug device, or drug product that is approved by the FDA for HIV preexposure prophylaxis and is covered by the plan or insurer without cost sharing. The bill would exempt Medi-Cal managed care plans from these provisions. 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.

(1) The California Constitution provides for the fundamental rights of privacy and to choose to have an abortion. Existing law, the Reproductive Privacy Act, prohibits the state from denying or interfering with a pregnant person's right to choose or obtain an abortion before the viability of the fetus, or when the abortion is necessary to protect the life or health of the pregnant person. Existing law prohibits conditions or restrictions from being imposed on abortion access for incarcerated persons and committed juveniles. Existing laws requiring parental consent for abortion and making assisting in or advertising abortion a crime have been held to be unconstitutional. This bill would repeal those unconstitutional provisions and delete obsolete references to criminal abortion penalties. The bill would make technical changes to provisions authorizing abortion for incarcerated and committed persons. (2) Existing law, the Sherman Food, Drug, and Cosmetic Law, provides for labeling requirements of drugs and devices. The Pharmacy Law requires a pharmacist to dispense a prescription in a container that is correctly labeled with specified information, including the name of the prescriber and the name address of the pharmacy. A violation of the Pharmacy Law is a misdemeanor. This bill would authorize the State Department of Public Health to adopt regulations to include or exclude mifepristone and other medication abortion drugs from the requirements of the Sherman Food, Drug, and Cosmetic Law, but would exclude the drugs from those requirements if the drugs are no longer approved by the United States Food and Drug Administration (FDA) , as specified. The bill would authorize a pharmacist to dispense mifepristone or other drug used for medication abortion without the name of the patient, the name of the prescriber, or the name and address of the pharmacy, subject to specified requirements. The bill would require the pharmacist to maintain a log, as specified, that is not open to inspection by law enforcement without a subpoena, and would prohibit the disclosure of the information to an individual or entity from another state. The bill would prohibit criminal, civil, professional discipline, or licensing action against a pharmacist for manufacturing, transporting, or engaging in specified other acts relating to mifepristone or other medication abortion drugs, and would prohibit the California State Board of Pharmacy from denying an application for licensure or taking disciplinary action against an applicant or licensee for engaging in certain acts relating to mifepristone or other medical abortion drugs. By expanding the scope of a crime under the Pharmacy Law, the bill would impose a state-mandated local program. (3) Existing law establishes various healing arts boards in the Department of Consumer Affairs that license and regulate various healing arts licensees. This bill would prohibit subjecting a healing arts practitioner who is authorized to prescribe, furnish, order, or administer dangerous drugs to civil, criminal, disciplinary, or other administrative action for prescribing, furnishing, ordering, or administering mifepristone or other medication abortion drugs for a use that is different from the use for which that drug has been approved for marketing by the FDA or that varies from an approved risk evaluation and mitigation strategy under federal law, as specified. The bill would state that the laws of another state or federal actions that interfere with the authority of a healing arts practitioner to take specified actions relating to mifepristone or other medication abortion drugs are against the public policy of this state. The bill would prohibit criminal, civil, professional discipline, or licensing actions against an applicant or licensee for manufacturing, transporting, or engaging in certain other acts relating to mifepristone or other medication abortion drugs. (4) Existing law provides for the licensure and regulation of clinics and health facilities by the State Department of Public Health. This bill would prohibit criminal, civil, professional discipline, or licensing action against a licensed clinic or health facility for transporting or engaging in certain other acts relating to mifepristone or other medication abortion drugs that are lawful in California. The bill would prohibit the department from denying an application for licensure or taking disciplinary action against an applicant or licensee for engaging in certain acts relating to mifepristone or other medical abortion drugs. (5) Existing law prohibits a health care provider from knowingly disclosing, transmitting, transferring, sharing or granting access to identifiable medical information related to an individual seeking, obtaining, providing, supporting, or aiding in the performance of an abortion that is lawful under the laws of this state, as specified and subject to specified exclusions. Existing law exempts a health care provider from liability for damages or from civil or enforcement actions for failing to comply this prohibition before January 31, 2026, if the health care provider is working diligently and in good faith to comply with the prohibition. This bill would exempt a health care provider from liability for damages or from civil or enforcement actions for an additional year, until January 31, 2027. (6) 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 disability and health insurers by the Department of Insurance. Existing law prohibits a health care service plan contract or a group or individual disability insurance policy or certificate that covers prescription drugs from limiting or excluding coverage of a drug on the basis that the drug is prescribed for a use that is different from the use for which that drug has been approved for marketing by the FDA. Existing law prohibits a contract between a health care service plan or health insurer and a health care services provider from containing any term that would result in termination or nonrenewal of the contract or otherwise penalize the provider based on a civil judgment, criminal conviction, or another professional disciplinary action in another state if the judgment, conviction, or professional disciplinary action is solely based on the application of another state's law that interferes with a person's right to receive care that would be lawful if provided in California. Existing law also prohibits a health care service plan or health insurer from discriminating against a licensed provider solely on the basis of a civil judgment, criminal conviction, or another professional disciplinary action in another state if the judgment, conviction, or professional disciplinary action is solely based on the application of another state's law that interferes with a person's right to receive care that would be lawful if provided in California. This bill would prohibit a health care service plan contract or a group or individual health insurance policy or certificate that covers prescription drugs from limiting or excluding coverage for brand name or generic mifepristone solely on the basis that the drug is prescribed for a use that is different from the use for which that drug has been approved for marketing by the FDA or that varies from an approved risk evaluation and mitigation strategy, except if the state deems it necessary to address an imminent health or safety concern. The bill would require those contracts and policies to include coverage for brand name or generic mifepristone, even if it has not been approved by the FDA if specified requirements are met, except if the state deems it necessary to address an imminent health or safety concern. The bill would prohibit a plan or insurer from contracting with a health care services provider to terminate or nonrenew the contract or otherwise penalize the provider, or from discriminating against a licensed provider, for manufacturing, transporting, or engaging in certain other acts relating to mifepristone or other medication abortion drugs that are lawful in California. Because a violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. (7) This bill would incorporate additional changes to Section 4076 of the Business and Professions Code proposed by AB 1503 to be operative only if this bill and AB 1503 are enacted and this bill is enacted last. (8) 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. (9) This bill would declare that it is to take effect immediately as an urgency statute.