Health care coverage: antiretroviral drugs.

Assembly Member Haney's legislation to modify California's health coverage requirements for HIV prevention medications would eliminate cost-sharing and prior authorization requirements for antiretroviral drugs starting in 2026. The measure, co-authored by Senator Wiener, applies to both health care service plans and insurance policies.

The bill prohibits insurers from imposing utilization review requirements or cost-sharing for FDA-approved or CDC-recommended antiretroviral drugs used in HIV prevention, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). While insurers must cover at least one therapeutically equivalent version of these medications without prior authorization, the bill specifies that long-acting injectable drugs with different durations are not considered therapeutically equivalent.

The legislation maintains existing provisions requiring coverage of PrEP and PEP furnished by pharmacists, including associated testing and services. Health plans must provide reimbursement for these services at in-network pharmacies and at out-of-network pharmacies if the plan includes out-of-network benefits. The measure also prohibits plans from preventing pharmacists from dispensing these medications, either directly or through pharmacy benefit managers.