Health care coverage: mental health or substance use disorders.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Appropriations
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill prohibits health care service plans and health insurance policies from requiring ‘step therapy’ – where a patient must try a different medication before a preferred one for serious mental illnesses or substance use disorders – starting January 1, 2027. It clarifies that this restriction doesn’t apply if there’s a clinical reason to require prior medication, and it specifically addresses this policy for Medi-Cal. The bill also includes provisions to prevent reimbursement for local agencies if the act creates a new crime or changes penalties.
Key provisions
- Prohibits step therapy for prescription drugs treating serious mental illnesses or substance use disorders in health insurance policies and health care service plans issued on or after January 1, 2027.
- Exempts step therapy if at least one therapeutic or clinical equivalent is available without it.
- Defines ‘serious mental illness’ and ‘step therapy’ for clarity.
- Specifically applies to Medi-Cal managed care plans with federal approval.
- Clarifies that the prohibition on step therapy does not apply when FDA labeling indicates prior medication is necessary.
- Excludes specialized health care service plans covering dental or vision benefits.
- States that no reimbursement is required for local agencies or school districts due to the creation of a new crime.
- Excludes dental-only, vision-only, and Medicare supplement insurance policies from the restrictions.
Who is affected
Bill text
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Sponsors
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3 on record
Primary sponsor
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