California changes health coverage requirements for antiretroviral products

What happened

SB 1023, signed September 26, updates coverage protections for medically necessary HIV/AIDS-prevention antiretroviral drugs, devices and products, including PrEP and PEP. For contracts or policies issued, amended or renewed on or after January 1, 2027, an FDA-approved non-self-administered prevention product must be covered under both the medical and prescription-drug benefits. A product obtained through the drug benefit must be dispensed and administered by a provider acting within the provider’s license. The rule is not limited to self-administered tablets or a single delivery channel.

The amended sections prohibit prior authorization or step therapy for the covered preventive products, but preserve the therapeutic-equivalent exception when at least one FDA-approved equivalent is available without those restrictions. They also protect pharmacist furnishing, related services and ordered testing within the stated authority and network-benefit conditions; the law does not require an out-of-network pharmacy benefit where none exists. Dental-, mental-health- or vision-only products and Medicare supplements are excluded. For Medi-Cal managed care, the section’s exclusion is tied to services excluded under the DHCS contract, rather than an unqualified statement that every Medi-Cal service is outside the law.

Why it matters

Medical and pharmacy benefit design, administration pathways and product-specific utilization edits must be reviewed together with the exceptions.

Sources

• SB 1023, bill historyOfficial · California Legislature · 2026-09-26 · Source review 2026-09-27
• Official retained source documentOfficial · Official issuing agency · Source review 2026-10-16
• Official retained source documentOfficial · Official issuing agency · Source review 2026-10-16
• Official retained source documentOfficial · Official issuing agency · Source review 2026-10-16