Senate BillChaptered/SignedHealth and Safety
SB 1023: Health care coverage: antiretroviral drugs, drug devices, and drug products.
What SB 1023 does, verified September 27, 2026
The bill would prohibit health care service plans and health insurers from subjecting antiretroviral drugs to prior authorization or step therapy for HIV/AIDS prevention. It would require coverage of non-self-administered antiretroviral drugs approved by the FDA for HIV/AIDS prevention as a medical benefit. The bill would also make a willful violation of these provisions a crime, requiring reimbursement by the state for the costs incurred. However, no reimbursement would be required if the non-compliance is due to a lack of authority from the state.
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Last action: Chaptered by Secretary of State. Chapter 470, Statutes of 2026. (2026-09-26)Alert me
Author and sponsors
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| Sep. 26, 2026 | Chaptered by Secretary of State. Chapter 470, Statutes of 2026. |
| Sep. 26, 2026 | Approved by the Governor. |
| Aug. 30, 2026 | Enrolled and presented to the Governor at 6 p.m. |
| Aug. 25, 2026 | Reconsideration granted. (Ayes 37. Noes 0.) |
| Aug. 25, 2026 | Motion to reconsider made by Senator Ashby. |
Latest bill textEnrolled version, August 27, 2026 · 1,575 words
| Enrolled August 27, 2026 |
| Passed IN Senate August 25, 2026 |
| Passed IN Assembly August 24, 2026 |
| Amended IN Assembly August 18, 2026 |
| Amended IN Senate March 16, 2026 |
CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION
Senate Bill
No. 1023
| Introduced by Senator Laird (Principal coauthor: Assembly Member Mark González) |
February 10, 2026 |
An act to amend Section 1342.74 of the Health and Safety Code, and to amend Section 10123.1933 of the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 1023, Laird. Health care coverage: antiretroviral drugs, drug devices, and drug products.
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 generally prohibits a health care service plan, excluding a Medi-Cal managed care plan, or health insurer from subjecting antiretroviral drugs that are medically necessary for the prevention of HIV/AIDS, including preexposure prophylaxis or postexposure prophylaxis, to prior authorization or step therapy. Under existing law, a health care service plan or health insurer is not required to cover all of the therapeutically equivalent versions of those drugs without prior authorization or step therapy if at least one is covered without prior authorization or step therapy.
This bill would instead prohibit a health care service plan, excluding a Medi-Cal managed care plan, or health insurer from subjecting antiretroviral drugs, drug devices, or drug products that are medically necessary for the prevention of HIV/AIDS to prior authorization or step therapy. The bill would require, for a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, a non-self-administered antiretroviral drug, drug device, or drug product that is approved by the United States Food and Drug Administration for the prevention of HIV/AIDS to be covered under both the plan or policy’s medical benefit and prescription drug benefit, and if obtained under the plan or policy’s drug benefit, would require the drug, device, or product to be dispensed and administered by a health care provider acting within the scope of their license. Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program.
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 1342.74 of the Health and Safety Code is amended to read:1342.74.
(a) (1) Notwithstanding Section 1342.71, a health care service plan shall not subject antiretroviral drugs, drug devices, or drug products that are medically necessary for the prevention of HIV/AIDS, including preexposure prophylaxis or postexposure prophylaxis, to prior authorization or step therapy, except as provided in paragraph (2).(2) If the United States Food and Drug Administration (FDA) has approved one or more therapeutic equivalents of a drug, drug device, or drug product for the prevention of HIV/AIDS, this section does not require a health care service plan to cover all of the therapeutically equivalent versions without prior authorization or step therapy, if at least one therapeutically equivalent version is covered without prior authorization or step therapy.
(b) Notwithstanding any other law, a health care service plan shall not prohibit, or permit a delegated pharmacy benefit manager to prohibit, a pharmacy provider from dispensing preexposure prophylaxis or postexposure prophylaxis.
(c) A health care service plan shall cover preexposure prophylaxis or postexposure prophylaxis that has been furnished by a pharmacist, as authorized in Sections 4052.02 and 4052.03 of the Business and Professions Code, including the pharmacist’s services and related testing ordered by the pharmacist. A health care service plan shall pay or reimburse, consistent with the requirements of this chapter, for the service performed by a pharmacist at an in-network pharmacy or a pharmacist at an out-of-network pharmacy if the health care service plan has an out-of-network pharmacy benefit.
(d) This section does not require a health care service plan to cover preexposure prophylaxis or postexposure prophylaxis by a pharmacist at an out-of-network pharmacy, unless the health care service plan has an out-of-network pharmacy benefit.
(e) Notwithstanding paragraph (2) of subdivision (f), for a health care service plan contract issued, amended, or renewed on or after January 1, 2027, a non-self-administered antiretroviral drug, drug device, or drug product that is approved by the FDA for the prevention of HIV/AIDS shall be covered under both the plan’s medical benefit and prescription drug benefit. If obtained under a plan’s prescription drug benefit, the antiretroviral drug, drug device, or drug product shall be dispensed and administered by a health care provider acting within the scope of their license.
(f) (1) This section does not apply to a specialized health care service plan contract that covers only dental, mental health, or vision benefits, or a Medicare supplement contract.
(2) This section applies regardless of whether or not an antiretroviral drug, drug device, or drug product is self-administered.
(3) This section does not apply to Medi-Cal managed care plans contracting with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), or Chapter 8.75 (commencing with Section 14590) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that the services described in this section are excluded from coverage under the contract between the Medi-Cal managed care plans and the State Department of Health Care Services.
SEC. 2.
Section 10123.1933 of the Insurance Code is amended to read:10123.1933.
(a) (1) Notwithstanding Section 10123.201, a health insurer shall not subject antiretroviral drugs, drug devices, or drug products that are medically necessary for the prevention of HIV/AIDS, including preexposure prophylaxis or postexposure prophylaxis, to prior authorization or step therapy, except as provided in paragraph (2).(2) If the United States Food and Drug Administration (FDA) has approved one or more therapeutic equivalents of a drug, drug device, or drug product for the prevention of HIV/AIDS, this section does not require a health insurer to cover all of the therapeutically equivalent versions without prior authorization or step therapy, if at least one therapeutically equivalent version is covered without prior authorization or step therapy.
(b) Notwithstanding any other law, a health insurer shall not prohibit, or permit a contracted pharmacy benefit manager to prohibit, a pharmacist from dispensing preexposure prophylaxis or postexposure prophylaxis.
(c) A health insurer shall cover preexposure prophylaxis or postexposure prophylaxis that has been furnished by a pharmacist, as authorized in Sections 4052.02 and 4052.03 of the Business and Professions Code, including the pharmacist’s services and related testing ordered by the pharmacist. A health insurer shall pay or reimburse, consistent with the requirements of this chapter, for the service performed by a pharmacist at an in-network pharmacy or a pharmacist at an out-of-network pharmacy if the health insurer has an out-of-network pharmacy benefit.
(d) Notwithstanding paragraph (2) of subdivision (e), for a health insurance policy issued, amended, or renewed on or after January 1, 2027, a non-self-administered antiretroviral drug, drug device, or drug product that is approved by the FDA for the prevention of HIV/AIDS shall be covered under both the insurer’s medical benefit and prescription drug benefit. If obtained under an insurer’s prescription drug benefit, the antiretroviral drug, drug device, or drug product shall be dispensed and administered by a health care provider acting within the scope of their license.
(e) (1) This section does not apply to a specialized health insurance policy that covers only dental, mental health, or vision benefits, or a Medicare supplement contract.
(2) This section applies regardless of whether or not an antiretroviral drug, drug device, or drug product is self-administered.
(f) The department and commissioner may exercise the authority provided by this code and the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340), Chapter 4.5 (commencing with Section 11400), and Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code) to implement and enforce this section. If the commissioner assesses an administrative penalty for a violation, any hearing that is requested by the insurer may be conducted by an administrative law judge of the administrative hearing bureau of the department under the formal procedure of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code. This subdivision does not impair or restrict the commissioner’s authority pursuant to another provision of this code or the Administrative Procedure Act.
SEC. 3.
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.Text of SB 1023 as enrolled, from the official record. Connect Plus keeps every version and highlights what changed.Compare versions