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 requires a health care service plan or health insurer to cover preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) furnished by a pharmacist, and prohibits a plan or insurer from subjecting antiretroviral drugs medically necessary for the prevention of AIDS/HIV to prior authorization or step therapy, except as specified. Existing law does not require a plan or insurer to cover all therapeutically equivalent versions of a drug, device, or product for the prevention of AIDS/HIV without prior authorization or step therapy.
This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, to cover specified antiretroviral drugs for the prevention of AIDS/HIV, including PrEP and PEP, and would prohibit the imposition of any cost-sharing or utilization review requirements for those drugs. The bill would specify that, for therapeutically equivalent coverage purposes, a long-acting injectable drug is not therapeutically equivalent to a long-acting injectable drug with a different duration. 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.

Statutes affected:
AB 602: 1342.74 HSC, 10123.1933 INS
02/13/25 - Introduced: 1342.74 HSC, 10123.1933 INS