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

Assembly Members Mark González and Haney propose comprehensive changes to California's health coverage requirements for HIV prevention medications through the Protecting Rights, Expanding Prevention, and Advancing Reimbursement for Equity (PrEPARE) Act of 2025.

The legislation prohibits health plans and insurers from requiring prior authorization, step therapy, or other protocols that delay access to FDA-approved or CDC-recommended antiretroviral drugs for HIV prevention. Plans must cover at least one therapeutically equivalent version without restrictions and provide other versions without cost-sharing through exception requests. The bill specifically notes that long-acting injectable drugs with different durations are not considered therapeutically equivalent.

Under the new requirements, health plans must cover preventive HIV medications furnished by pharmacists, including related testing and services. The legislation mandates coverage under outpatient prescription benefits and allows direct supply to providers. Both grandfathered and non-grandfathered plans are prohibited from imposing cost-sharing or utilization review requirements for these medications.

The bill includes targeted exemptions and implementation timelines. Medi-Cal managed care plans, specialized dental/vision plans, and Medicare supplement policies are exempt from the new requirements. For individual and small group health plans, the provisions take effect January 1, 2027. High-deductible health plans must comply with the cost-sharing limits after meeting annual deductibles to maintain federal compliance.