AB 1887
Prescription drug coverage for rare diseases.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Appropriations
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Sign in to take action- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill aims to improve access to prescription drugs for patients with rare diseases in California. It requires health care service plans and health insurance policies issued on or after January 1, 2027, to expedite prior authorization processes for these medications, aiming for a 30-day turnaround. The bill also prohibits ‘step therapy,’ which requires patients to try alternative treatments before receiving a rare disease drug, unless a suitable alternative is available. It clarifies the definition of ‘rare disease’ and includes an exception for Medi-Cal managed care contracts.
Key provisions
- Requires health plans to complete prior authorization within 30 days for rare disease drugs prescribed by specialists.
- Prohibits ‘step therapy’ for rare disease drugs unless biosimilar, interchangeable, or generic options are available.
- Defines ‘rare disease’ as affecting fewer than 200,000 people in the United States.
- Excludes Medi-Cal managed care contracts from the requirements.
- Establishes a 30-day timeframe for initial prior authorization requests.
- Specifies that approval occurs if a decision isn't made within 30 days or a dispute remains ongoing.
- Clarifies that a specialist’s determination of medical necessity is key for prior authorization.
- States that no reimbursement is required for local agencies or school districts due to the creation of a new crime.
Who is affected
- Patients with rare diseases
- Health care service plans
- Health insurers
- Specialists treating rare diseases
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AB1887:v96#DOCUMENT
Bill Start
| Amended IN Senate July 02, 2026 |
| Amended IN Assembly May 20, 2026 |
| Amended IN Assembly March 26, 2026 |
CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION
Assembly Bill
No. 1887
| Introduced by Assembly Member Zbur (Principal coauthors: Assembly Members Alanis, Caloza, Dixon, Jeff Gonzalez, Lee, Ransom, and Ward) (Principal coauthors: Senators Becker and Blakespear) (Coauthors: Assembly Members Addis, Bauer-Kahan, Connolly, and Pellerin) |
| February 12, 2026 |
An act to add Section 1342.76 to the Health and Safety Code, and to add Section 10123.1936 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 1887, as amended, Zbur. Prescription drug coverage for rare diseases.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified prior authorization and step therapy limitations for health care service plans and health insurers.
This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, to require a health care service plan or health insurer to complete prior authorization or other utilization review within 30 days upon initial request, as specified, for a drug approved for the treatment of a rare disease if the drug is prescribed by a specialist with expertise in the condition or disease being treated and the specialist has determined the drug is medically necessary, unless a biosimilar, interchangeable biologic, or generic version of the drug is available. The bill would prohibit a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2027, from imposing step therapy for these drugs. necessary. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
Bill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1342.76 is added to the Health and Safety Code, to read:
1342.76.
(a) (1) A health care service plan contract issued, amended, or renewed on or after January 1, 2027, shall require a health care service plan to complete prior authorization or other utilization review within 30 days upon initial request for a prescription drug approved by the United States Food and Drug Administration that is approved for the treatment of a rare disease if the drug is prescribed by a specialist with expertise in the condition or disease being treated and the specialist has determined the drug is medically necessary, unless a biosimilar, interchangeable biologic, or generic version of the drug is available. necessary.
(2) For purposes of paragraph (1), an initial request occurs when a health care provider or the health care provider’s staff sends a prior authorization request or utilization review request to the health care service plan or health care service plan’s delegate.
(3) Prior authorization or other utilization review for a drug prescribed pursuant to paragraph (1) shall be immediately approved under either of the following conditions:
(A) A decision approving or denying prior authorization or other utilization review has not been made by the end of the 30-day period.
(B) A dispute between the plan and provider or enrollee regarding the prior authorization or other utilization review is ongoing at the end of the 30-day period.
(b)Notwithstanding any other law, a health care service plan contract issued, amended, or renewed on or after January 1, 2027, shall not impose step therapy for a drug approved by the United States Food and Drug Administration that is approved for the treatment of a rare disease if the drug is prescribed by a specialist with expertise in the condition or disease being treated and the specialist has determined the drug is medically necessary, unless a biosimilar, interchangeable biologic, or generic version of the drug is available.
(c)
(b) For purposes of this section, “rare disease” means a disease that affects fewer than 200,000 people in the United States.
(d)
(c) This section does not affect the timelines described in paragraph (2) of subdivision (h) of Section 1367.01.
(e)
(d) This section does not apply to Medi-Cal managed care contracts with the State Department of Health Care Services entered into pursuant to Chapter 7 (commencing with Section 14000) of, or Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 2.
Section 10123.1936 is added to the Insurance Code, to read:
10123.1936.
(a) (1) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall require a health insurer to complete prior authorization or other utilization review within 30 days upon initial request for a prescription drug approved by the United States Food and Drug Administration that is approved for the treatment of a rare disease if the drug is prescribed by a specialist with expertise in the condition or disease being treated and the specialist has determined the drug is medically necessary, unless a biosimilar, interchangeable biologic, or generic version of the drug is available. necessary.
(2) For purposes of paragraph (1), an initial request occurs when a health care provider or the health care provider’s staff sends a prior authorization request or utilization review request to the health insurer or health insurer’s delegate.
(3) Prior authorization or other utilization review for a drug prescribed pursuant to paragraph (1) shall be immediately approved under either of the following conditions:
(A) A decision approving or denying prior authorization or other utilization review has not been made by the end of the 30-day period.
(B) A dispute between the insurer and provider or insured regarding the prior authorization or other utilization review is ongoing at the end of the 30-day period.
(b)Notwithstanding any other law, a health insurance policy issued, amended, or renewed on or after January 1, 2027, shall not impose step therapy for a drug approved by the United States Food and Drug Administration that is approved for the treatment of a rare disease if the drug is prescribed by a specialist with expertise in the condition or disease being treated and the specialist has determined the drug is medically necessary, unless a biosimilar, interchangeable biologic, or generic version of the drug is available.
(c)
(b) For purposes of this section, “rare disease” means a disease that affects fewer than 200,000 people in the United States.
(d)
(c) This section does not affect the timelines described in paragraph (2) of subdivision (h) of Section 10123.135.
SEC. 3.
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.