Health care coverage: antiretroviral drugs, drug devices, and drug products.

Assembly Members Mark González and Haney's PrEPARE Act of 2025 modifies California health plan requirements for HIV prevention medications, eliminating prior authorization and step therapy requirements for antiretroviral drugs, devices, and products used in HIV/AIDS prevention.

The legislation requires health plans and insurers to cover FDA-approved antiretroviral medications for HIV pre-exposure prophylaxis without cost sharing, while maintaining an exception that allows prior authorization if at least one therapeutically equivalent version is covered without restrictions. The bill specifically defines long-acting drugs with different durations as non-equivalent, preventing plans from requiring step therapy between these options. Health plans covering non-self-administered antiretrovirals as a medical benefit must also include them as an outpatient prescription drug benefit.

Under the new requirements, health plans cannot restrict pharmacists from dispensing pre-exposure or post-exposure prophylaxis medications and must cover these drugs when furnished by pharmacists, including associated testing and services. The legislation exempts specialized plans covering only dental, mental health, or vision benefits, Medicare supplement contracts, and Medi-Cal managed care plans. For high-deductible health plans, cost-sharing limitations apply after the plan's deductible has been met to maintain compliance with federal requirements.