California changes health coverage requirements for antiretroviral products

What happened

California enacted SB 1023 on September 26 as Chapter 470. The amended plan and insurer provisions prohibit prior authorization or step therapy for medically necessary HIV-prevention antiretroviral drugs, drug devices, and drug products, including preexposure and postexposure prophylaxis. The therapeutic-equivalent exception remains: where FDA-approved equivalents exist, at least one must be available without those restrictions, but every equivalent need not be. The surrounding provisions also preserve the identified pharmacist furnishing, related testing, and reimbursement protections, with the stated network-benefit conditions.

For contracts and policies issued, amended, or renewed on or after January 1, 2027, an FDA-approved non-self-administered HIV-prevention drug, device, or product must be covered under both medical and prescription-drug benefits. When obtained through the prescription benefit, a health care provider acting within license scope must dispense and administer it. The sections exclude the specified specialized dental, mental-health-only, vision, and Medicare supplement arrangements. The plan section also preserves its Medi-Cal managed-care exception to the extent the services are excluded from the DHCS contract; that condition should not be restated as a universal exclusion of every Medi-Cal service.

Why it matters

California-regulated plans and delegated pharmacy or utilization-management functions may need benefit, formulary, authorization, and member-communication changes.

Sources

• SB 1023, bill historyOfficial · California Legislature · 2026-09-26 · Source review 2026-09-27
• SB1023 current official textOfficial · California Legislature · 2026-09-26 · Source review 2026-10-11
• California Constitution, Article IV section 8(c), official Assembly 2023–24 editionOfficial · California State Assembly · Source review 2026-10-14