AB 1843 limits prior authorization for covered hepatitis C antivirals
Oct 11, 2026 edition · GC-2026-0245 · Published 2026-10-11 · Version 3 · Final
AB 1843 limits prior authorization for medically necessary direct-acting hepatitis C antivirals. A pangenotypic therapeutic-equivalence exception and the plan provision's Medi-Cal exclusion remain material to applying the new commercial controls.
What happened
The parallel plan and insurer provisions prohibit prior authorization for direct-acting antiviral drugs medically necessary to treat hepatitis C, subject to the stated exception. The protected category is defined by drug function and medical necessity. It is not a repeal of every pharmacy review or a direction to treat all drugs used by a patient with hepatitis C as interchangeable antivirals.
When FDA-approved therapeutic equivalents of a pangenotypic drug, device, or product exist, the law does not require all equivalent versions to bypass authorization if at least one pangenotypic, therapeutically equivalent version is covered without it. The plan section expressly excludes Medi-Cal managed care contracts. A formulary or dispensing review therefore needs to identify the qualifying no-authorization option and the member's product, rather than either retaining authorization on every equivalent or removing it from unrelated treatments.
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
- Recorded date
- 2027-01-01
- Date type
- effective
Why it matters
Pharmacy and specialty treatment access depend on correctly scoped benefit edits.
Recommended action
Identify affected products and statutory scope, revise qualifying prior authorization edits and validate dispensing and claims workflows.
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 2026-10-11
- California Constitution, Article IV section 8(c), official Assembly 2023–24 editionOfficial · California State Assembly · Source review 2026-10-14
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
Read the entire Medicare & Medicaid report →