Health care coverage: antiretroviral drugs, drug devices, and drug products.

The document was reformatted from a traditional enrolled bill layout (with blank fields for dates, page numbers, and signature lines) to a web-based presentation including navigation elements, a digest key showing Vote: MAJORITY, Appropriation: NO, Fiscal Committee: YES, Local Program: YES, and explicit session/author metadata.

Entirely new provisions added to Health and Safety Code Section 1342.74 and Insurance Code Section 10123.1933 requiring health care service plans and health insurers to cover HIV/AIDS prevention drugs (antiretroviral drugs, drug devices, and drug products) without prior authorization or step therapy.

The bill's title and digest changed from covering only insurance (technical changes to Section 753) to also covering health care coverage for antiretroviral drugs, drug devices, and drug products. A principal coauthor (Assembly Member Mark Gonzalez) was added.

Health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 2027 that cover non-self-administered FDA-approved antiretroviral drugs, drug devices, or drug products for HIV/AIDS prevention as a medical benefit must also include them as an outpatient prescription drug benefit.

Plans and insurers must cover PrEP and PEP furnished by pharmacists (including pharmacist services and related testing) and pay for in-network pharmacy services, plus out-of-network if the plan has an out-of-network pharmacy benefit. Out-of-network coverage is not required except in medical emergencies.

New enforcement provision authorizing the Department of Insurance commissioner to implement and enforce the new HIV prevention drug coverage requirements through administrative penalties, with hearings conducted by administrative law judges under formal Administrative Procedure Act procedures.

Exemptions added: specialized plans covering only dental, mental health, or vision benefits; Medicare supplement contracts; and Medi-Cal managed care plans to the extent HIV prevention services are excluded from their state contracts. The provisions apply regardless of whether the drug is self-administered.

Fiscal committee review changed from 'no' to 'yes' and state-mandated local program changed from 'no' to 'yes', reflecting the new regulatory obligations imposed on health plans and insurers. A no-reimbursement clause was added under Article XIII B of the California Constitution.

The original Section 753 amendments (removing redundant words like 'any' before 'a' in the insurance agent kickback prohibition) were retained but renumbered as a later section after the new HIV prevention provisions.

Entire amendment to Insurance Code Section 753 (prohibiting insurance agents or brokers from receiving financial benefits from auto repair facilities for referring insureds) is removed. This was an unrelated provision bundled into the bill.

New requirement that non-self-administered FDA-approved antiretroviral drugs, drug devices, or drug products for HIV/AIDS prevention must be covered under both the medical benefit and the outpatient prescription drug benefit of health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 2027.

New requirement that if a non-self-administered antiretroviral drug, device, or product is obtained under the prescription drug benefit, it must be dispensed and administered by a health care provider acting within the scope of their license.

Standardized terminology from 'AIDS/HIV' to 'HIV/AIDS' throughout, changed 'and or' to 'or' in references to preexposure and postexposure prophylaxis, and corrected a drafting error that listed both Section 753 and Section 10123.1933 in the bill's title.

Fiscal committee vote changed from 'no' to 'yes' in the legislative counsel's digest.