Assembly BillIntroducedHealth and Safety
AB 2000: Drug formularies.
What AB 2000 does, verified June 8, 2026
<p>The bill amends existing laws regarding drug formularies in health care service plans and insurers. It prohibits changes to formularies during a plan year, except under specific circumstances, such as when a change is necessary due to safety concerns or new medical evidence. If a change requires an enrollee to switch drugs within the same class, they can stay on their current drug if it was previously approved for their condition and deemed safe and effective. The bill mandates at least 90 days' notice before implementing such changes.</p> <p>Plans must report any formulary changes to the relevant department within 30 days. Departments have authority to investigate noncompliance, impose penalties, and conduct audits. Additionally, the bill defines an "expeditious process" for obtaining authorization of nonformulary drugs, requiring approval within 72 hours or 24 hours in urgent cases…
Bill journey
1IntroducedCurrent
2In CommitteePending
3First Chamber FloorPending
4Second ChamberPending
5GovernorPending
6ChapteredPending
Last action: In committee: Held under submission. (2026-05-14)Alert me
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| May. 14, 2026 | In committee: Held under submission. |
| May. 14, 2026 | Joint Rule 62(a), file notice suspended. (Page 5030.) |
| May. 13, 2026 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr. 20, 2026 | Re-referred to Com. on APPR. |
| Apr. 16, 2026 | Read second time and amended. |
Latest bill textAmended version, April 16, 2026 · 1,625 words
| Amended IN Assembly April 16, 2026 |
| Amended IN Assembly March 09, 2026 |
CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION
Assembly Bill
No. 2000
| Introduced by Assembly Member Aguiar-Curry |
February 17, 2026 |
An act to add Section 1367.208 to amend Section 1367.24 of, and to add Section 1367.208 to, the Health and Safety Code, and to add Section 10123.2041 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2000, as amended, Aguiar-Curry. Drug formularies.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer that provides prescription drug benefits and maintains one or more drug formularies to meet certain criteria for its formularies and the placement of drugs on formularies.
This bill would prohibit a health care service plan or health insurer that provides prescription drug benefits and maintains one or more drug formularies from making changes to a formulary during a plan or policy year, except in specified circumstances. If a plan or insurer implements a formulary change requiring an enrollee or insured to change to a different drug in the same drug class during the plan year, the bill would authorize the individual to remain on the previously covered drug for the rest of the plan year if the drug was previously approved for coverage for the individual’s medical condition, is appropriately prescribed, and is considered safe and effective for treating that condition, and would require the plan or insurer to notify the individual and their provider no less than 90 days before the change is implemented. The bill would require a plan or insurer, or its pharmacy benefit manager, to report to the appropriate department any changes made to a formulary during a plan or policy year within 30 days of the change being made. The bill would authorize the departments to impose investigate and take enforcement action against a plan or insurer for noncompliance with the above-described requirements and to impose, after notice and the opportunity for a hearing, administrative penalties, as specified, for a violation of these provisions. The bill would authorize the departments to conduct audits related to these provisions. Because a willful violation of the bill’s provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
Existing law requires a health care service plan that provides prescription drug benefits to maintain an expeditious process by which prescribing providers may obtain authorization for a medically necessary nonformulary prescription drug.
This bill would define “expeditious process” for the above-described purpose to require a plan to approve authorization within 72 hours for nonurgent requests, or within 24 hours if exigent circumstances exist, of a request for approval of a drug prescription. If the plan fails to meet those requirements, the bill would authorize an enrollee to request, and would require the plan to provide, 90 days of transitional coverage to the enrollee for the previously covered drug. The bill would require the Department of Managed Health Care to utilize existing data and its existing authority to collect data from plans and annually publish on its internet website and submit to the Legislature an aggregated report on information related to requests for approval of a nonformulary drug as described above.
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 1367.208 is added to the Health and Safety Code, to read:1367.208.
(a)(b) Notwithstanding subdivision (a), a health care service plan may make changes to a formulary for any of the following reasons:
(1) To add a newly approved drug. If a generic drug is newly approved, the cost sharing for the newly approved generic drug shall be lower than the brand name drug, but brand name drug coverage shall not be removed until the end of the plan year. an additional drug to the formulary.
(2) (A) To replace a covered drug on the formulary with another drug in the same drug class. The enrollee’s cost sharing for the newly covered drug during the plan year shall be the same as or lower than the cost-sharing amount for the previously covered drug.
(B) To replace a covered brand name drug on the formulary with a generic drug of the same drug class. The enrollee’s cost sharing for the newly covered drug during the plan year shall be lower than the cost-sharing amount for the previously covered drug.
(C) To replace a covered brand name drug on the formulary with a generic drug of the same drug. The enrollee’s cost sharing for the newly covered drug during the plan year shall be lower than the cost-sharing amount for the previously covered drug.
(3) To add a biosimilar or interchangeable biologic product that is the same or similar to a previously covered drug or reference product if the net cost to the plan and the amount of the enrollee’s cost sharing is the same as or lower than the net cost to the plan and the cost-sharing amount for the previously covered drug or reference product.
(2)
(4)
To remove a drug due to safety concerns from the United States Food and Drug Administration.(3)
(5)
To move a specified drug to a lower formulary tier or otherwise modify its formulary placement in a manner that reduces enrollee cost sharing.(4)
(6)
To remove utilization management or prior authorization requirements for a covered drug.(c) (1) If the plan implements a formulary change requiring an enrollee to change to a different drug in the same drug class during the plan year, the enrollee may remain on the previously covered drug for the rest of the plan year if all of the following conditions are met:
(A) The drug was previously approved for coverage by the plan for a medical condition of the enrollee.
(B) The drug is appropriately prescribed to the enrollee.
(C) The drug is considered safe and effective for treating the enrollee’s medical condition.
(2) If the plan requires an enrollee to change to a different drug as described in paragraph (1), the plan shall notify the enrollee and their prescribing provider no less than 90 days before the formulary change is implemented. The notification shall include information about existing requirements for continuity of coverage for previously covered drugs as described in Section 1367.22.
(3) This subdivision does not prohibit the prescribing provider from prescribing a different drug that is covered by the plan that is medically appropriate for the enrollee.
(4) This subdivision does not prohibit the prescribing provider from prescribing a generic drug substitution as described in Section 4073 of the Business and Professions Code.
(c)
(d) (1) A health care service plan or its pharmacy benefit manager shall report to the department any changes made to a formulary during a plan year within 30 days of the change being made.
(2) A health care service plan shall authorize appeals for coverage denials based on formulary changes through its existing internal and external appeals processes.
(d)(1)The department may impose an administrative penalty for a violation of this section of not less than five hundred dollars ($500) per 1,000 enrollees and up to five thousand dollars ($5,000) per 1,000 enrollees.
(e) (1) (A) The director may investigate and take enforcement action against a plan for noncompliance with the requirements of this section.
(B) The director may, by order, assess administrative penalties of not less than five hundred dollars ($500) per 1,000 enrollees and up to five thousand dollars ($5,000) per 1,000 enrollees, subject to appropriate notice of, and the opportunity for, a hearing in accordance with Section 1397.
(2) When assessing administrative penalties against a health care service plan pursuant to paragraph (1), the department shall determine the appropriate penalty amount for each violation based on one or more factors as applicable, including the factors outlined in subdivision (d) of Section 1386.
(3) The plan may provide to the director, and the director may consider for the purposes of the determination described in paragraph (2), information regarding the plan’s overall compliance with the requirements of this section.
(3)
(4)
Beginning January 1, 2030, and every five years thereafter, the penalty amounts specified in paragraph (1) shall be adjusted based on the average rate of change in premium rates for the individual and small group markets, and weighted by enrollment, since the previous adjustment.(4)
(5)
Penalties levied by the department on a plan pursuant to this subdivision shall be paid by the plan and shall not be paid by the provider, subscriber, or enrollee. (e)
(f) The department may conduct audits that relate to this section and are not based on an enrollee’s complaint.
(f)
(g) For purposes of this section, “formulary” has the same meaning as defined in Section 1367.205.
Text of AB 2000 as amended, from the official record. Connect Plus keeps every version and highlights what changed.Compare versions