CA AB1826

Health care service plan contracts and health insurance policies covering outpatient prescription drug benefits must provide coverage for pain medications prescribed by a licensed health care professional without requiring the subscriber or insured to first use an alternative prescription drug or over-the-counter drug.

Plans and policies may require patients to first use a generically equivalent drug (drugs with identical active chemical ingredients, strength, quantity, dosage form, and generic drug name as determined by USAN and FDA).

Plans and policies may still charge copayments, deductibles, or apply maximum coverage limitations on prescription drug benefits, provided these are reported to and approved by the Department of Managed Health Care director or Insurance Commissioner.

Exempts health care service plans and health insurance policies purchased by the Board of Administration of the Public Employees' Retirement System from these requirements.

Does not require coverage of drugs not in a plan's formulary or prohibit generic drug substitutions authorized by existing law.