Anthony Portantino
- Democratic
- Senator
- District 25
Author
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 would 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 either approved by the United States Food and Drug Administration (FDA) or recommended by the federal Centers for Disease Control and Prevention (CDC) 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 and the plan or insurer provides coverage for a noncovered therapeutic equivalent antiretroviral drug, drug device, or drug product without cost sharing pursuant to an exception request. The bill would require a plan or insurer to provide coverage under the outpatient prescription drug benefit for those drugs, drug devices, or drug products, including by supplying participating providers directly with a drug, drug device, or drug product, as specified. This bill would require a nongrandfathered or grandfathered health care service plan contract or health insurance policy to provide coverage for antiretroviral drugs, drug devices, or drug products that are either approved by the FDA or recommended by the CDC for the prevention of HIV/AIDS, and would prohibit a nongrandfathered or grandfathered health care service plan contract or health insurance policy from imposing any cost-sharing or utilization review requirements for those drugs, drug devices, or drug products. The bill would exempt Medi-Cal managed care plans from these provisions and would delay the application of these provisions for an individual and small group health care service plan contract or health insurance policy until January 1, 2026. 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.
In Assembly. Held at Desk.
Ordered to the Assembly.
In Senate. Concurrence in Assembly amendments pending.
Read third time. Passed. (Ayes 62. Noes 0. Page 4746.) Ordered to the Senate.
Read third time and amended.
Ordered to third reading.
Ordered to third reading.
From inactive file.
Notice of intention to remove from inactive file given by Assembly Member Zbur.
Ordered to inactive file on request of Assembly Member Zbur.
Ordered to third reading.
Read third time and amended.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 13. Noes 1.) (September 1).
August 23 set for first hearing. Placed on suspense file.
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 12. Noes 0.) (July 11).
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
In Assembly. Read first time. Held at Desk.
Read third time. Passed. (Ayes 33. Noes 1. Page 1276.) Ordered to the Assembly.
From committee: Do pass. (Ayes 5. Noes 1. Page 1170.) (May 18).
Read second time. Ordered to third reading.
Set for hearing May 18.
May 8 hearing: Placed on APPR suspense file.
Set for hearing May 8.
From committee: Do pass and re-refer to Com. on APPR. (Ayes 10. Noes 0. Page 940.) (April 26). Re-referred to Com. on APPR.
Set for hearing April 26.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS.
From printer. May be acted upon on or after March 16.
Introduced. Read first time. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB427 | HTML |
| 02/13/23 - Introduced | |
| 03/21/23 - Amended Senate | |
| 06/13/23 - Amended Assembly | |
| 08/14/23 - Amended Assembly | |
| 09/08/23 - Amended Assembly | |
| 04/04/24 - Amended Assembly |
| Document | Format |
|---|---|
| 04/24/23- Senate Health | |
| 05/05/23- Senate Appropriations | |
| 05/20/23- Sen. Floor Analyses | |
| 07/07/23- Assembly Health | |
| 08/21/23- Assembly Appropriations | |
| 09/05/23- ASSEMBLY FLOOR ANALYSIS | |
| 09/08/23- ASSEMBLY FLOOR ANALYSIS | |
| 04/04/24- ASSEMBLY FLOOR ANALYSIS | |
| 04/12/24- Sen. Floor Analyses |
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