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		<ns0:Id>20250AB__055493ENR</ns0:Id>
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				<ns0:ActionText>INTRODUCED</ns0:ActionText>
				<ns0:ActionDate>2025-02-11</ns0:ActionDate>
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				<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
				<ns0:ActionDate>2025-03-03</ns0:ActionDate>
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				<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
				<ns0:ActionDate>2025-05-23</ns0:ActionDate>
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			<ns0:Action>
				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-06-24</ns0:ActionDate>
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			<ns0:Action>
				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-07-17</ns0:ActionDate>
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				<ns0:ActionText>AMENDED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-09-04</ns0:ActionDate>
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				<ns0:ActionDate>2025-09-10</ns0:ActionDate>
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				<ns0:ActionText>PASSED_SENATE</ns0:ActionText>
				<ns0:ActionDate>2025-09-09</ns0:ActionDate>
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				<ns0:ActionText>ENROLLED</ns0:ActionText>
				<ns0:ActionDate>2025-09-12</ns0:ActionDate>
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		<ns0:LegislativeInfo>
			<ns0:SessionYear>2025</ns0:SessionYear>
			<ns0:SessionNum>0</ns0:SessionNum>
			<ns0:MeasureType>AB</ns0:MeasureType>
			<ns0:MeasureNum>554</ns0:MeasureNum>
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		<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Members Mark González and Haney</ns0:AuthorText>
		<ns0:AuthorText authorType="PRINCIPAL_COAUTHOR_OPPOSITE">(Principal coauthor: Senator Wiener)</ns0:AuthorText>
		<ns0:AuthorText authorType="COAUTHOR_ORIGINATING">(Coauthors: Assembly Members Jackson, Wallis, and Ward)</ns0:AuthorText>
		<ns0:Authors>
			<ns0:Legislator>
				<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
				<ns0:House>ASSEMBLY</ns0:House>
				<ns0:Name>Mark González</ns0:Name>
			</ns0:Legislator>
			<ns0:Legislator>
				<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
				<ns0:House>ASSEMBLY</ns0:House>
				<ns0:Name>Haney</ns0:Name>
			</ns0:Legislator>
			<ns0:Legislator>
				<ns0:Contribution>PRINCIPAL_COAUTHOR</ns0:Contribution>
				<ns0:House>SENATE</ns0:House>
				<ns0:Name>Wiener</ns0:Name>
			</ns0:Legislator>
			<ns0:Legislator>
				<ns0:Contribution>COAUTHOR</ns0:Contribution>
				<ns0:House>ASSEMBLY</ns0:House>
				<ns0:Name>Jackson</ns0:Name>
			</ns0:Legislator>
			<ns0:Legislator>
				<ns0:Contribution>COAUTHOR</ns0:Contribution>
				<ns0:House>ASSEMBLY</ns0:House>
				<ns0:Name>Wallis</ns0:Name>
			</ns0:Legislator>
			<ns0:Legislator>
				<ns0:Contribution>COAUTHOR</ns0:Contribution>
				<ns0:House>ASSEMBLY</ns0:House>
				<ns0:Name>Ward</ns0:Name>
			</ns0:Legislator>
		</ns0:Authors>
		<ns0:Title>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. </ns0:Title>
		<ns0:RelatingClause>health care coverage</ns0:RelatingClause>
		<ns0:GeneralSubject>
			<ns0:Subject>Health care coverage: antiretroviral drugs, drug devices, and drug products.</ns0:Subject>
		</ns0:GeneralSubject>
		<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 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 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.</html:p>
			<html:p>This bill, the Protecting Rights, Expanding Prevention, and Advancing Reimbursement for Equity (PrEPARE) Act of 2025, 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, but would authorize prior authorization or step therapy if at least one therapeutically equivalent version is covered without prior authorization or step therapy. The bill would specify that, for therapeutically equivalent coverage purposes, a long-acting drug, drug device, or drug product is not
			 therapeutically equivalent to a long-acting drug, drug device, or drug product with a different duration. The bill would require a plan or insurer that covers non-self-administered antiretroviral drugs, drug devices, or drug products that are approved by the United States Food and Drug Administration (FDA) for the prevention of HIV/AIDS as a medical benefit to also include those non-self-administered antiretroviral drugs, drug devices, or drug products as an outpatient prescription drug benefit.</html:p>
			<html:p>This bill would require a nongrandfathered health care service plan contract or health insurance policy to provide coverage for antiretroviral drugs, drug devices, or drug products that are approved by the FDA for HIV preexposure prophylaxis, and would prohibit a nongrandfathered
			 health care service plan contract or health insurance policy from imposing any cost sharing for those drugs, drug devices, or drug products. The bill would prohibit a plan or insurer from imposing cost sharing on a nonformulary antiretroviral drug, drug device, or drug product that is approved by the FDA for HIV preexposure prophylaxis and is covered pursuant to an exception request if the nonformulary antiretroviral drug, drug device, or drug product is therapeutically equivalent to a formulary antiretroviral drug, drug device, or drug product that is approved by the FDA for HIV preexposure prophylaxis and is covered by the plan or insurer without cost sharing. The bill would exempt Medi-Cal managed care plans from these provisions.</html:p>
			<html:p> 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.</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:DigestKey>
			<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:ImmediateEffect>NO</ns0:ImmediateEffect>
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				<ns0:Urgency>NO</ns0:Urgency>
				<ns0:TaxLevy>NO</ns0:TaxLevy>
				<ns0:Election>NO</ns0:Election>
				<ns0:UsualCurrentExpenses>NO</ns0:UsualCurrentExpenses>
				<ns0:BudgetBill>NO</ns0:BudgetBill>
				<ns0:Prop25TrailerBill>NO</ns0:Prop25TrailerBill>
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	<ns0:Bill id="bill">
		<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
		<ns0:BillSection id="id_5A423E6E-130C-49B9-A6F2-D70F7C7EAAFF">
			<ns0:Num>SECTION 1.</ns0:Num>
			<ns0:Content>
				<html:p>This act shall be known, and may be cited, as the Protecting Rights, Expanding Prevention, and Advancing Reimbursement for Equity (PrEPARE) Act of 2025.</html:p>
			</ns0:Content>
		</ns0:BillSection>
		<ns0:BillSection id="id_DE02F8E3-8C25-427B-A96A-3CDFFA516B2C">
			<ns0:Num>SEC. 2.</ns0:Num>
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				Section 1342.74 of the 
				<ns0:DocName>Health and Safety Code</ns0:DocName>
				 is amended to read:
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				<ns0:LawSection id="id_06BE9A27-2CA1-4F51-A650-B351FB529BC2">
					<ns0:Num>1342.74.</ns0:Num>
					<ns0:LawSectionVersion id="id_2F1A652D-D2F2-4E8F-B25A-E46FBA40793A">
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							<html:p>
								(a)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								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).
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								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. For purposes of this section, a long-acting drug, drug device, or drug product is not therapeutically equivalent to a long-acting drug, drug device, or drug product with a different duration.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								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.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								A health care service plan shall cover preexposure prophylaxis and 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.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								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 in the case of a medical emergency or if the health care service plan has
						an out-of-network pharmacy benefit.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								A nongrandfathered health care service plan contract shall provide coverage, and shall not impose any cost sharing, for antiretroviral drugs, drug devices, or drug products that are approved by the FDA for HIV preexposure prophylaxis.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A health care service plan shall not impose cost sharing on a nonformulary antiretroviral drug, drug device, or drug product
						that is approved by the FDA for HIV preexposure prophylaxis and covered pursuant to an exception request if the nonformulary antiretroviral drug, drug device, or drug product is therapeutically equivalent to a formulary antiretroviral drug, drug device, or drug product that is approved by the FDA for HIV preexposure prophylaxis and that is covered by the health care service plan without cost sharing. 
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								Notwithstanding paragraph (2) of subdivision (g), a health care service plan that covers non-self-administered antiretroviral drugs, drug devices, or drug products that are approved by the FDA for the prevention of HIV/AIDS as a medical benefit shall also include those non-self-administered antiretroviral drugs, drug
						devices, or drug products that are approved by the FDA for the prevention of HIV/AIDS as an outpatient prescription drug benefit. 
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								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.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								This section applies regardless of whether or not an antiretroviral drug, drug device, or drug product is self-administered.
							</html:p>
							<html:p>
								(3)
								<html:span class="EnSpace"/>
								This section shall 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.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								A health care service plan contract that is a high deductible health plan under the definition set forth in Section 223(c)(2) of Title 26 of the United States Code shall comply with the cost-sharing requirements of this section. However, if not applying the minimum annual deductible to an antiretroviral drug, drug device, or drug product would conflict with federal requirements for high deductible health plans, the cost-sharing limits shall apply once a contract’s deductible has been satisfied for the plan year.
							</html:p>
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		<ns0:BillSection id="id_62750F6B-706E-4751-8CF1-4C045A71CF77">
			<ns0:Num>SEC. 3.</ns0:Num>
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				Section 10123.1933 of the 
				<ns0:DocName>Insurance Code</ns0:DocName>
				 is amended to read:
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				<ns0:LawSection id="id_F1A63E87-3110-4A96-A056-F1CFE70DDB67">
					<ns0:Num>10123.1933.</ns0:Num>
					<ns0:LawSectionVersion id="id_1035D551-624C-4DA1-8A5F-2286D944BE47">
						<ns0:Content>
							<html:p>
								(a)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								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).
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								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. For purposes of this section, a long-acting drug, drug device, or drug product is not therapeutically equivalent to a long-acting drug, drug device, or drug product with a different duration.
							</html:p>
							<html:p>
								(b)
								<html:span class="EnSpace"/>
								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.
							</html:p>
							<html:p>
								(c)
								<html:span class="EnSpace"/>
								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.
							</html:p>
							<html:p>
								(d)
								<html:span class="EnSpace"/>
								This section does not require a health insurer to cover preexposure prophylaxis or postexposure prophylaxis by a pharmacist at an out-of-network pharmacy, unless
						in the case of a medical emergency or if the health insurance policy has an out-of-network pharmacy benefit.
							</html:p>
							<html:p>
								(e)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								A nongrandfathered health insurance policy shall provide coverage, and shall not impose any cost sharing, for antiretroviral drugs, drug devices, or drug products that are approved by the FDA for HIV preexposure prophylaxis.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								A health insurer shall not impose cost sharing on a nonformulary antiretroviral drug, drug device, or drug product
						that is approved by the FDA for HIV preexposure prophylaxis and covered pursuant to an exception request if the nonformulary antiretroviral drug, drug device, or drug product is therapeutically equivalent to a formulary antiretroviral drug, drug device, or drug product that is approved by the FDA for HIV preexposure prophylaxis and that is covered by the health insurer without cost sharing.
							</html:p>
							<html:p>
								(f)
								<html:span class="EnSpace"/>
								Notwithstanding paragraph (2) of subdivision (g), a health insurer that covers non-self-administered antiretroviral drugs, drug devices, or drug products that are approved by the FDA for the prevention of HIV/AIDS as a medical benefit shall also include those non-self-administered antiretroviral drugs, drug devices, or drug
						products that are approved by the FDA for the prevention of HIV/AIDS as an outpatient prescription drug benefit.
							</html:p>
							<html:p>
								(g)
								<html:span class="EnSpace"/>
								(1)
								<html:span class="EnSpace"/>
								This section does not apply to a specialized health insurance policy that covers only dental, mental health, or vision benefits or a Medicare supplement policy.
							</html:p>
							<html:p>
								(2)
								<html:span class="EnSpace"/>
								This section applies regardless of whether or not an antiretroviral drug, drug device, or drug product is self-administered.
							</html:p>
							<html:p>
								(h)
								<html:span class="EnSpace"/>
								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.
							</html:p>
							<html:p>
								(i)
								<html:span class="EnSpace"/>
								A health insurance policy that is a high deductible health plan under the definition set forth in Section 223(c)(2) of Title 26 of the United States Code shall comply with the cost-sharing requirements of this section. However, if not applying the minimum annual deductible to an antiretroviral drug,
						drug device, or drug product would conflict with federal requirements for high deductible health plans, the cost-sharing limits shall apply once a policy’s deductible has been satisfied for the plan year.
							</html:p>
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			<ns0:Num>SEC. 4.</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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