Communicable diseases: hepatitis C.

Plain English Breakdown

The exact nature of the tests and information that health care service plans and insurance companies cannot request is not specified in the provided official source material.

Hepatitis C Treatment: No Prior Authorization

AB-1843 stops health care plans and insurers from requiring prior approval before giving out direct-acting antiviral drugs needed to treat hepatitis C, but it doesn't force them to cover all similar drugs without approval.

What This Bill Does

• It prohibits health care service plans and insurance companies from requiring prior authorization for direct-acting antiviral drugs used to treat hepatitis C that are medically necessary.
• These provisions do not require health care service plans or insurers to cover all therapeutically equivalent versions of these drugs without prior authorization.
• Health care service plans and insurers must align their clinical criteria for hepatitis C treatment with current guidelines set by medical groups like the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America.
• It prohibits health care service plans and insurance companies from requesting certain tests or information when deciding if they will cover hepatitis C treatment.

Who It Names or Affects

• People with hepatitis C who need direct-acting antiviral drugs.
• Health care service plans and insurance companies that provide coverage for these drugs.

Terms To Know

Prior Authorization

A process where a health plan or insurer needs to approve a drug before it can be given to a patient.

Direct-Acting Antiviral Drugs

Medicines used to treat hepatitis C by stopping the virus from spreading in the body.

Limits and Unknowns

• The bill does not require health plans or insurers to cover all similar drugs without prior authorization.
• It is unclear how this will affect people who already have restrictions on their coverage for hepatitis C treatment.

Official Summary Text

AB 1843, as amended, Elhawary.
Communicable diseases: hepatitis
B and
C.
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.
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
authorization, as specified. The bill
would require a health care service plan and health insurer’s clinical criteria for hepatitis C treatment
and prior authorization
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.
Diseases and the Infectious Diseases Society of America or generally accepted clinical practice guidelines of another nonprofit health care provider professional association or specialty society pertaining to clinical hepatology or infectious disease. The bill would prohibit a plan or insurer, for the purpose of determining prior authorization for hepatitis C treatment, from requesting specified tests or information.
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.
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.

Current Bill Text

Download Bill PDF