Health care coverage: antisteering.

Assembly Member Wilson's prescription drug access legislation prohibits health insurers and pharmacy benefit managers from restricting where patients obtain and receive medications starting in 2026. The measure bars practices that limit patient choice in medication dispensing and administration, including requirements to use specific pharmacies or self-administer certain drugs against medical advice.

The bill establishes comprehensive protections against "steering" tactics in prescription drug coverage. Health plans and insurers may not mandate the use of mail-order or retail pharmacies when providers determine another dispensing method better serves the patient. The legislation also prevents plans from imposing higher cost-sharing when medications are administered in physicians' offices rather than through mail-order pharmacies. Additionally, insurers cannot deny payment to in-network providers who obtain drugs from out-of-network pharmacies when medical necessity criteria are met.

To preserve physician autonomy in medication dispensing, the measure prohibits discriminatory contracting practices against providers who dispense prescriptions directly to patients. Plans may not include contract terms that discourage physician dispensing, terminate provider agreements based on dispensing activities, or retaliate against physicians who exercise their dispensing rights. The bill defines pharmacy benefit managers as entities that manage prescription coverage, including claims processing, prior authorization, and pharmacy network contracting.