CA SB598

Prohibits health care service plans and health insurers from requiring prior authorization for covered health care services from contracted health professionals who had 90% or more of their prior authorization requests approved in the most recent completed one-year period, effective January 1, 2026.

Requires health professionals to have at least 36 months of contracting history with the plan or insurer to be eligible for the exemption, and mandates electronic prior authorization processes be available.

Establishes procedures for denying, rescinding, and appealing prior authorization exemptions, including requirements that decisions be made by licensed health professionals of the same or similar specialty and that health professionals receive detailed information supporting any denial.

Requires plans and insurers to annually monitor prior authorization approval rates and discontinue requiring prior authorization for services, items, and supplies that are approved 95% of the time.

Includes brand name prescription drugs as covered services under the exemption through January 1, 2029, and requires the Department of Managed Health Care and Department of Insurance to report on the costs, savings, and administrative impact of the program by July 1, 2029.