Senate BillChaptered/SignedHealth and Safety
SB 950: Health care coverage: dementia.
What SB 950 does, verified September 29, 2026
<blockquote> <p>The bill adds requirements for health care service plan contracts and health insurance policies to cover medically necessary treatments or medications approved by the FDA for Alzheimer's disease or related dementia, starting January 1, 2027. It prohibits insurers from requiring step therapy protocols as a prerequisite for coverage of these treatments. The bill does not require coverage for pharmaceutically equivalent drug products if more than one is approved by the FDA.</p> </blockquote>
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Last action: Chaptered by Secretary of State. Chapter 662, Statutes of 2026. (2026-09-27)Alert me
Author and sponsors
Full contact details, staff, and committees with Connect, $16/moUnlockRecent actions26 total · showing 5
| Sep. 27, 2026 | Chaptered by Secretary of State. Chapter 662, Statutes of 2026. |
| Sep. 27, 2026 | Approved by the Governor. |
| Aug. 30, 2026 | Enrolled and presented to the Governor at 6 p.m. |
| Aug. 25, 2026 | Assembly amendments concurred in. (Ayes 40. Noes 0.) Ordered to engrossing and enrolling. |
| Aug. 24, 2026 | Read third time. Passed. (Ayes 77. Noes 0. Page 6373.) Ordered to the Senate. |
Latest bill textChaptered version, September 27, 2026 · 1,379 words
Senate Bill No. 950
CHAPTER 662
An act to add Section 1373.15 to the Health and Safety Code, and to add Section 10123.175 to the Insurance Code, relating to health care coverage.
[ Approved by Governor September 27, 2026. Filed with Secretary of State September 27, 2026. ]
LEGISLATIVE COUNSEL'S DIGEST
SB 950, Weber Pierson. Health care coverage: dementia.
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’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law prohibits specified health care service plan contracts and disability insurance policies from excluding persons covered by the plan from receiving benefits if they are diagnosed as having any significant destruction of brain tissue with resultant loss of brain function, including Alzheimer’s disease.
This bill would require a health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 2027, to include coverage for all medically necessary treatments or medications, as determined by a health care provider, approved by the United States Food and Drug Administration (FDA) for the treatment of Alzheimer’s disease or other medical conditions affecting memory. On and after January 1, 2027, the bill would prohibit a health care service plan or health insurer from imposing step therapy protocols as a prerequisite to authorizing that coverage, except as provided. Because a willful violation of these provisions by a health care service plan would be a crime, the 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 1373.15 is added to the Health and Safety Code, to read:1373.15.
(a) (1) A health care service plan contract that is issued, amended, or renewed on or after January 1, 2027, shall include coverage for all medically necessary treatments or medications, as determined by a health care provider, approved by the United States Food and Drug Administration (FDA) for the treatment of Alzheimer’s disease or other medical conditions affecting memory. Medically necessary treatments or medications include, but are not limited to, those that reduce clinical decline.(2) Medically necessary treatments or medications covered pursuant to paragraph (1) include those administered through a medical benefit, an outpatient prescription drug benefit to the extent the health care service plan contract covers outpatient prescription drugs, or both.
(b) (1) On and after January 1, 2027, a health care service plan shall not impose step therapy protocols as a prerequisite to authorizing coverage of medically necessary treatments or medications approved by the FDA for the treatment of Alzheimer’s disease or other medical conditions affecting memory, except as provided in paragraph (3). For purposes of this section, “step therapy protocol” means a process that specifies the sequence in which different prescription drugs for a given medical condition and medically appropriate for a particular patient are prescribed.
(2) For purposes of this subdivision, step therapy is prohibited for both self-administered drugs and physician-administered drugs, except as provided in paragraph (3).
(3) If the FDA has approved one or more types of treatment for Alzheimer’s disease or other medical conditions affecting memory, this section does not require a health care service plan to cover all types of treatment for Alzheimer’s disease or other medical conditions affecting memory without step therapy, if at least one antiamyloid therapy is covered without step therapy.
(c) Except as provided in subdivision (b), this section does not prohibit a health care service plan from applying utilization management, including prior authorization, to determine the medical necessity for treatment of Alzheimer’s disease or other medical conditions affecting memory if appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by the plan contract.
(d) Coverage criteria for FDA-approved treatments described in this section shall not be more restrictive than the FDA-approved indications for those treatments.
(e) For purposes of this section, authorization for a medically necessary treatment approved by the FDA for the treatment of Alzheimer’s disease or other medical conditions affecting memory shall be considered an exigent circumstance, consistent with the requirements of Section 1367.241.
(f) This section does not apply to the following:
(1) A specialized health care service plan contract that covers only dental or vision benefits or a Medicare supplement contract.
(2) A Medi-Cal managed care plan contract 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 14591) of Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 2.
Section 10123.175 is added to the Insurance Code, to read:10123.175.
(a) (1) A health insurance policy that is issued, amended, or renewed on or after January 1, 2027, shall include coverage for all medically necessary treatments or medications, as determined by a health care provider, approved by the United States Food and Drug Administration (FDA) for the treatment of Alzheimer’s disease or other medical conditions affecting memory. Medically necessary treatments or medications include, but are not limited to, those that reduce clinical decline.(2) Medically necessary treatments or medications covered pursuant to paragraph (1) include those administered through a medical benefit, an outpatient prescription drug benefit to the extent the health insurance policy covers outpatient prescription drugs, or both.
(b) (1) On and after January 1, 2027, a health insurer shall not impose step therapy protocols as a prerequisite to authorizing coverage of medically necessary treatments or medications approved by the FDA for the treatment of Alzheimer’s disease or other medical conditions affecting memory, except as provided in paragraph (3). For purposes of this section, “step therapy protocol” means a process that specifies the sequence in which different prescription drugs for a given medical condition and medically appropriate for a particular patient are prescribed.
(2) For purposes of this subdivision, step therapy is prohibited for both self-administered drugs and physician-administered drugs, except as provided in paragraph (3).
(3) If the FDA has approved one or more types of treatment for Alzheimer’s disease or other medical conditions affecting memory, this section does not require a health insurer to cover all types of treatment for Alzheimer’s disease or other medical conditions affecting memory without step therapy, if at least one antiamyloid therapy is covered without step therapy.
(c) Except as provided in subdivision (b), this section does not prohibit a health insurer from applying utilization management, including prior authorization, to determine the medical necessity for treatment of Alzheimer’s disease or other medical conditions affecting memory if appropriateness and medical necessity determinations are made in the same manner as those determinations are made for the treatment of any other illness, condition, or disorder covered by the plan contract.
(d) Coverage criteria for FDA-approved treatments described in this section shall not be more restrictive than the FDA-approved indications for those treatments.
(e) For purposes of this section, authorization for a medically necessary treatment approved by the FDA for the treatment of Alzheimer’s disease or other medical conditions affecting memory shall be considered an exigent circumstance, consistent with the requirements of Section 10123.191.
(f) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, or Medicare supplement insurance policies.
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 950 as chaptered, from the official record. Connect Plus keeps every version and highlights what changed.Compare versions