AMENDED IN SENATE AUGUST 21, 2026

AMENDED IN SENATE JUNE 8, 2026

AMENDED IN ASSEMBLY MARCH 2, 2026

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

96

Introduced by Assembly Member Elhawary

February 11, 2026

An act to add Section 1342.76 1342.77 to the Health and Safety Code, and to add Section 10123.1936 10123.1937 to the Insurance Code, relating to public health.

Vote: majority   Appropriation: no   Fiscal committee: yes   Local program: yes

LEGISLATIVE COUNSEL’S DIGEST

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 also provides for the regulation of health insurers by the Department of Insurance. Existing law generally prohibits a health care service plan or health insurer from subjecting antiretroviral drugs that are medically necessary for the prevention of HIV/AIDS to prior authorization or step therapy.

This bill would prohibit a health care service plan and health insurer from subjecting direct-acting antiviral drugs that are medically necessary for the treatment of hepatitis C to prior authorization. The bill would specify that these provisions do not require a health care service plan or health insurer to cover all therapeutically equivalent versions without prior authorization, as specified. The bill would require a health care service plan and health insurer’s clinical criteria for hepatitis C treatment and prior authorization to align with current guidelines and the standard of care consistent with the standards of the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America or generally accepted clinical practice guidelines of another nonprofit health care provider professional association or specialty society pertaining to clinical hepatology or infectious disease. The bill would prohibit a plan or insurer, for the purpose of determining prior authorization for hepatitis C treatment, from requesting specified tests or information. Because a 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.

The people of the State of California do enact as follows:

SECTION 1.

Section 1342.77 is added to the Health and Safety Code, to read:

1342.77.

(a) (1)A health care service plan shall not subject direct-acting antiviral drugs that are medically necessary for the treatment of hepatitis C to prior authorization, except as provided in paragraph (2). subdivision (b).

(b) If the United States Food and Drug Administration has approved one or more therapeutic equivalents of a pangenotypic drug, device, or product for the treatment of hepatitis C, this section does not require a health care service plan to cover all of the therapeutically equivalent versions without prior authorization, if at least one pangenotypic and therapeutically equivalent version is covered without prior authorization.

SEC. 2.

Section 10123.1937 is added to the Insurance Code, to read:

10123.1937.

(a) (1)A health insurer shall not subject direct-acting antiviral drugs that are medically necessary for the treatment of hepatitis C to prior authorization, except as provided in paragraph (2). subdivision (b).

(b) If the United States Food and Drug Administration has approved one or more therapeutic equivalents of a pangenotypic drug, device, or product for the treatment of hepatitis C, this section does not require a health insurer to cover all of the therapeutically equivalent versions without prior authorization, if at least one pangenotypic and therapeutically equivalent version is covered without prior authorization.

SEC. 3.

No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.