AB 1843 limits prior authorization for covered hepatitis C antivirals
Oct 4, 2026 edition · GC-2026-0245 · Published 2026-10-04 · Version 2 · Final
AB 1843 restricts prior authorization for medically necessary hepatitis C direct-acting antivirals, with a therapeutic-equivalent exception.
What happened
California approved and filed AB 1843 on September 27. The enacted plan and insurer provisions prohibit prior authorization for direct-acting antiviral drugs medically necessary to treat hepatitis C, subject to the statute’s therapeutic-equivalent exception. Where FDA has approved one or more therapeutic equivalents of a pangenotypic treatment, a carrier need not cover every therapeutically equivalent version without prior authorization if at least one pangenotypic and therapeutically equivalent version is available without it. The precise access rule therefore depends on the treatment and available equivalent, rather than a blanket removal of all pharmacy review.
The plan section expressly excludes Medi-Cal managed care contracts. The new restriction addresses prior authorization for the specified medically necessary hepatitis C drugs; it does not itself create coverage for every unrelated product or indication. As of October 4, it is enacted text for implementation preparation, with applicable commencement and any regulatory instructions to be confirmed. Pharmacy and clinical teams can identify affected edits now, but must distinguish the protected treatment pathway from lawful review of other versions under the exception and from requirements outside the statute’s scope.
Scope and timing
- Authority status
- Final
- Applicability
- Potentially applicable
- Audience
- Health systems, Provider networks, Health-tech
- Jurisdiction
- California
- Affected functions
- Managed Care, Compliance, Clinical Operations
- Responsible owner
- Managed Care
Why it matters
A correctly configured exception can preserve prompt access to qualifying hepatitis C treatment without incorrectly treating every antiviral or therapeutic version as exempt.
Recommended action
Confirm commencement, affected products and the available pangenotypic equivalent pathway. Prepare prior-authorization edit changes and test dispensing and claims against the statutory exception.
Implementation playbook
- Confirm affected members, benefits and contracts against the final statutory scope. Managed Care · Due 2026-10-18
- Identify affected products and statutory scope, revise qualifying prior authorization edits and validate dispensing and claims workflows. Compliance · Due 2026-11-15
- Validate updated workflows, communicate changes and monitor implementing guidance. Compliance · Due 2026-12-15
Sources
- AB1843 enacted final textOfficial · California Legislature · 2026-09-27 · Source review 2026-10-05
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
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