Health care coverage: antisteering.

Plain English Breakdown

The official source material does not provide specific penalties for companies that do not comply with the new rules.

Health Care Coverage: Antisteering Practices

AB-577 stops health care service plans, insurers, and pharmacy benefit managers from forcing patients to use specific pharmacies or doctors for prescription drugs.

What This Bill Does

• Stops health care companies from making people go to specific pharmacies for their medicine.
• Prevents these companies from putting unfair rules on in-network doctors when it comes to giving out prescription drugs.
• Requires healthcare providers to get permission and give cost estimates before giving certain medicines that need to be injected or infused.

Who It Names or Affects

• Health care service plans
• Insurance companies
• Pharmacy benefit managers
• Patients who get prescription drugs

Terms To Know

Steering practices

When health care companies try to direct patients to certain pharmacies or doctors.

In-network

Doctors and hospitals that are part of a patient's insurance plan, usually offering lower costs.

Limits and Unknowns

• The bill does not specify how much it will cost to enforce these rules.
• It is unclear if there will be any penalties for companies that do not follow the new rules.
• There are no details on how local agencies and schools will be affected by this law.

Official Summary Text

AB 577, as amended, Wilson.
Health care coverage: antisteering.
Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes the willful violation of its provisions a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy that provides coverage for outpatient prescription drugs to cover medically necessary prescription drugs.
For a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026, this bill would prohibit a health care service plan, health insurer, or pharmacy benefit manager from engaging in specified steering practices, including, among others, requiring an enrollee or insured to use a retail pharmacy for dispensing prescription
oral medications, as specified, and imposing any requirements, conditions, or exclusions that discriminate against
a
an in-network
physician in connection with dispensing prescription oral medications.
The bill would require a health care provider, physician’s office, clinic, or infusion center to obtain consent from an enrollee or insured and disclose a good faith estimate of the enrollee’s or insured’s applicable cost-sharing amount before supplying or administering an injected or infused medication to an enrollee or insured, or sending an enrollee or insured to receive an injected or infused medication, if the setting or manner of administration is different than the setting or manner of administration for which the health care service
plan, health insurer, or pharmacy benefit manager directed the enrollee or insured, as specified.
Because a willful violation of these provisions
by a health care service plan
relative to health care service plans
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