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<ns0:Id>20250AB__184398AMD</ns0:Id>
<ns0:VersionNum>98</ns0:VersionNum>
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<ns0:Action>
<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-11</ns0:ActionDate>
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<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2026-03-02</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:MeasureType>AB</ns0:MeasureType>
<ns0:MeasureNum>1843</ns0:MeasureNum>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Elhawary</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
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<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Elhawary</ns0:Name>
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<ns0:Title> An act to add Section 1342.76 to the Health and Safety Code, and to add Section 10123.1936 to the Insurance Code, relating to public health. </ns0:Title>
<ns0:RelatingClause>public health</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Communicable diseases: hepatitis B and C.</ns0:Subject>
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<ns0:DigestText>
<html:p>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 also provides for the regulation of health insurers by the Department of Insurance. Existing law generally prohibits a health care service plan or health insurer from subjecting antiretroviral drugs that are medically necessary for the prevention of HIV/AIDS to prior authorization or step therapy.</html:p>
<html:p>This bill would prohibit a health care service plan and health insurer from subjecting direct-acting antiviral drugs that are medically necessary for the treatment of hepatitis C to prior authorization. The
bill would specify that these provisions do not require a health care service plan or health insurer to cover all therapeutically equivalent versions without prior authorization. The bill would prohibit a health care service plan and health insurer from imposing prior authorization requirements, as specified, and would require a health care service plan and health insurer’s clinical criteria for hepatitis C treatment to align with current guidelines and the standard of care consistent with the standards of the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. Because a violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program.</html:p>
<html:p>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.</html:p>
<html:p>This bill would provide that no reimbursement is required by this act for a specified reason.</html:p>
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<ns0:VoteRequired>MAJORITY</ns0:VoteRequired>
<ns0:Appropriation>NO</ns0:Appropriation>
<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
<ns0:LocalProgram>YES</ns0:LocalProgram>
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<ns0:Urgency>NO</ns0:Urgency>
<ns0:TaxLevy>NO</ns0:TaxLevy>
<ns0:Election>NO</ns0:Election>
<ns0:UsualCurrentExpenses>NO</ns0:UsualCurrentExpenses>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_1250F6FA-90A9-49AD-85D2-9A806150CEBB">
<ns0:Num>SECTION 1.</ns0:Num>
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Section 1342.76 is added to the
<ns0:DocName>Health and Safety Code</ns0:DocName>
, to read:
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<ns0:LawSection id="id_955A0594-5690-43F2-ABC4-387DA419106F">
<ns0:Num>1342.76.</ns0:Num>
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<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A health care service plan shall not subject direct-acting antiviral drugs that are medically necessary for the treatment of hepatitis C, including, but not limited to, sofosbuvir/velpatasvir, sofosbuvir/ledipasvir, glecaprevir/pibrentasvir, or elbasvir/grazoprevir, to prior authorization, except as provided in paragraph (2).
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<html:p>
(2)
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If the United States Food and Drug Administration has approved one or more therapeutic equivalents of a drug, device, or product for the treatment of hepatitis C, this section does not require a health care service plan to cover all of the therapeutically equivalent versions without prior authorization, if at least one
therapeutically equivalent version is covered without prior
authorization.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
A health care service plan’s clinical criteria for hepatitis C treatment and prior authorization shall align with the current guidelines and the standard of care consistent with the standards of the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, and shall not impose prior authorization requirements, including, but not limited to, all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A liver biopsy.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Genotype testing.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Sobriety requirements.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Fibrosis staging thresholds.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Elastography or FibroScan documentation.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
Ultrasound documentation.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
A specialist referral or evaluation.
</html:p>
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 10123.1936 is added to the
<ns0:DocName>Insurance Code</ns0:DocName>
, to read:
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<ns0:LawSection id="id_F79C4E63-7211-4655-9599-65A5144C32DC">
<ns0:Num>10123.1936.</ns0:Num>
<ns0:LawSectionVersion id="id_F391B091-D22C-47B5-A00C-B00BF0C2627A">
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<html:p>
(a)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A health insurer shall not subject direct-acting antiviral drugs that are medically necessary for the treatment of hepatitis C, including, but not limited to, sofosbuvir/velpatasvir, sofosbuvir/ledipasvir, glecaprevir/pibrentasvir, or elbasvir/grazoprevir, to prior authorization, except as provided in paragraph (2).
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
If the United States Food and Drug Administration has approved one or more therapeutic equivalents of a drug, device, or product for the treatment of hepatitis C, this section does not require a health insurer to cover all of the therapeutically equivalent versions without prior authorization, if at least one
therapeutically equivalent version is covered without prior authorization.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
A health insurer’s clinical criteria for hepatitis C treatment and prior authorization shall align with the current guidelines and the standard of care consistent with the standards of the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, and shall not impose prior authorization requirements, including, but not limited to, all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
A liver biopsy.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Genotype testing.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Sobriety requirements.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
Fibrosis staging thresholds.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Elastography or FibroScan documentation.
</html:p>
<html:p>
(6)
<html:span class="EnSpace"/>
Ultrasound documentation.
</html:p>
<html:p>
(7)
<html:span class="EnSpace"/>
A specialist referral or evaluation.
</html:p>
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</ns0:LawSection>
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<ns0:BillSection id="id_A1FFA75F-2C63-4469-B275-68DD78020E9E">
<ns0:Num>SEC. 3.</ns0:Num>
<ns0:Content>
<html:p>
No reimbursement is required by this act pursuant to Section 6 of Article XIII
<html:span class="ThinSpace"/>
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
<html:span class="ThinSpace"/>
B of the California Constitution.
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