CA SB1021

Extends cost-sharing limits for outpatient prescription drugs until January 1, 2024: maximum $250 copayment/coinsurance for a 30-day supply (or $500 for bronze-level plans), except for high deductible health plans after deductible is met.

Limits drug formularies to a maximum of 4 tiers for nongrandfathered individual and small group plans, with specified definitions for each tier based on drug type, cost, and clinical characteristics.

Requires that if a pharmacy's retail price is less than the applicable copayment or coinsurance amount, enrollees/insureds shall only pay the retail price, which counts toward deductibles and out-of-pocket limits.

Extends until January 1, 2023 the requirement that health plans cover single-tablet antiretroviral drug regimens for AIDS/HIV prevention (in addition to existing treatment requirement), unless multitablet regimens are clinically equally or more effective.

Applies to both health care service plans (regulated by Department of Managed Health Care) and health insurers (regulated by Department of Insurance), but excludes plans contracted with the State Department of Health Care Services.