AB 2400 Summary

• Requires health plans and insurers to resolve grievances involving formulary drug prior authorization denials within 72 hours for non-urgent requests and 24 hours when exigent circumstances exist.

• Allows enrollees to file external exception requests for nonformulary drugs in lieu of filing internal grievances, and requires plans to treat grievances filed after nonformulary drug denials as external exception request reviews.

• Requires health plans and insurers offering individual, small group, or large group coverage to comply with federal external exception request review processes under 45 CFR Section 156.122(c) for both formulary and nonformulary drugs.

• Exempts Medi-Cal managed care plans from the new prescription drug grievance and external review requirements.

• Specifies that willful violations by health care service plans constitute crimes and establishes that no state reimbursement is required for compliance costs incurred by local agencies.