Prescription drug coverage for rare diseases.

Plain English Breakdown

The official source material does not provide specific consequences if a cheaper version is available, nor does it detail how violations are enforced beyond existing criminal penalties under the Knox-Keene Health Care Service Plan Act of 1975.

Prescription Drug Coverage for Rare Diseases

AB-1887 prohibits health care service plans and insurance companies from requiring prior authorization, step therapy, or other utilization review steps for rare disease drugs if a specialist determines the drug is medically necessary, unless there's a cheaper version available.

What This Bill Does

• Prohibits health care service plan contracts or health insurance policies issued, amended, or renewed on or after January 1, 2027, from imposing prior authorization, step therapy, or other utilization review for rare disease drugs if prescribed by a specialist with expertise in the condition and determined to be medically necessary.
• Requires that these plans cannot impose additional approval steps unless there is a cheaper biosimilar, interchangeable biologic, or generic version of the drug available.

Who It Names or Affects

• People who have health insurance or belong to health care service plans in California.
• Health insurers and managed health care companies in California.

Terms To Know

Prior authorization

A process where a doctor needs approval from an insurance company before prescribing certain medications.

Step therapy

A requirement that patients try less expensive drugs first before getting more costly ones.

Limits and Unknowns

• The bill does not specify what happens if a cheaper version of the drug is available.
• It only applies to contracts and policies issued, amended, or renewed on or after January 1, 2027.

Official Summary Text

AB 1887, as amended, Zbur.
Prescription drug coverage for rare diseases.
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 sets forth specified prior authorization and step therapy limitations for health care service plans and health insurers.
This bill would prohibit a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, from imposing prior authorization, step therapy, or other utilization review for a drug
prescribed
approved
for the treatment of a rare
disease, as specified,
disease if the drug is prescribed by a specialist with expertise in the condition or disease being treated and the specialist has determined the drug is medically necessary,
unless a biosimilar, interchangeable biologic, or generic version of the drug is available. Because a willful violation of this provision 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.

Current Bill Text

Download Bill PDF