SB 427 Summary

• Prohibits health care service plans and health insurers from subjecting antiretroviral drugs, drug devices, or drug products approved by the FDA or recommended by the CDC for HIV/AIDS prevention (including PrEP and PEP) to prior authorization or step therapy, with limited exceptions when therapeutic equivalents are available.

• Requires plans and insurers to provide coverage for antiretroviral drugs without cost-sharing or utilization review requirements for nongrandfathered and grandfathered plans, effective January 1, 2026, but excludes individual and small group plans and Medi-Cal managed care plans.

• Prohibits plans and insurers from restricting pharmacy providers from dispensing preexposure prophylaxis or postexposure prophylaxis, and requires coverage of these medications furnished by pharmacists including associated services and testing.

• Requires plans and insurers to provide outpatient prescription drug coverage for antiretroviral drugs, including non-self-administered versions supplied directly to providers, and permits exception requests for noncovered therapeutic equivalents without cost sharing.

• Exempts specialized dental/vision plans, Medicare supplement plans, and Medi-Cal managed care plans from requirements; provides that high deductible health plans must comply with cost-sharing rules once deductibles are satisfied.