California SB964: Prescription drug coverage: dose adjustments.

What the bill says

An act to add Section 1367.225 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage. health care coverage Prescription drug coverage: dose adjustments. 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…

From the chaptered text, September 27, 2026:

An act to add Section 1367.225 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage. health care coverage Prescription drug coverage: dose adjustments. 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 authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified. This bill would authorize an enrollee’s or insured’s treating contracting provider to submit a written request to a health care service plan or health insurer requesting the authority to adjust the dose or frequency of a drug to meet the specific medical needs of …

Read the full official text

Sponsors

• Lola Smallwood-Cuevas (D, SD28) · primary sponsor