CA SB306

Requires the Department of Managed Health Care and Department of Insurance to issue instructions by July 1, 2026, for health plans and insurers to report statistics on prior authorization approvals, modifications, and denials for covered services

Health plans and insurers must report prior authorization data by December 31, 2026, including information from any entities to which they delegate prior authorization decisions

Departments must identify services approved at 90% or higher rates and publish a list by July 1, 2027; plans and insurers must stop requiring prior authorization for these frequently approved services by January 1, 2028

Plans and insurers may reinstate prior authorization for specific providers only with clear and convincing evidence of fraudulent activity or a pattern of clinically inappropriate care resulting in patient harm or excessive resource utilization

Prior authorization may still be required for tier 3-4 formulary drugs, off-label uses, experimental treatments, novel therapy applications, and out-of-network providers; the provisions sunset on January 1, 2034