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 public health.
Summary
AB 1843 would prohibit California health care service plans and health insurers from requiring prior authorization for direct-acting antiviral drugs that are medically necessary to treat hepatitis C. The bill specifically names several common hepatitis C medications, including sofosbuvir/velpatasvir, sofosbuvir/ledipasvir, glecaprevir/pibrentasvir, and elbasvir/grazoprevir. It also limits the ability of plans and insurers to impose additional utilization-management hurdles by requiring their clinical criteria to align with current hepatitis C treatment guidelines and the standard of care.
The bill further bars plans and insurers from requesting certain tests or documentation as a condition of prior authorization for hepatitis C treatment, including liver biopsy, genotype testing, sobriety proof, fibrosis staging thresholds, elastography or FibroScan documentation, ultrasound documentation, and specialist referral or evaluation. It preserves some flexibility for coverage of therapeutically equivalent versions of a drug, so long as at least one pangenotypic equivalent is available without prior authorization. The measure applies to both health care service plans regulated under Knox-Keene and health insurers regulated by the Department of Insurance.
Impact
AB 1843 would amend the Health and Safety Code and Insurance Code to create new coverage and utilization-review standards for hepatitis C treatment in California’s regulated health plans and insurers. It would effectively remove prior authorization barriers for medically necessary direct-acting antiviral therapy and prohibit several common pre-treatment documentation requirements, thereby expanding access to treatment and constraining plan/insurer medical management practices. Because violations by health care service plans are treated as crimes under existing law, the bill also creates a state-mandated local program, though it states no reimbursement is required.
Sentiment
The available voting history suggests the bill has generally received favorable support, advancing out of committee with strong majority votes, including a 12-2 vote on April 21 and a later 8-1 committee recommendation to do pass and re-refer to Appropriations. No committee transcript is provided, so there is no recorded floor or committee debate to indicate broader public testimony or detailed arguments. Overall, the bill appears to have been viewed as a patient-access measure aimed at reducing administrative barriers to hepatitis C treatment.
Contention
The main point of contention appears to be the bill’s restriction on prior authorization and related documentation requirements, which limits insurer discretion in managing hepatitis C drug coverage. Potential opponents would likely be health plans and insurers concerned about reduced utilization controls, while supporters would be patient advocates and public health stakeholders focused on timely access to curative treatment. The bill’s carve-out allowing coverage of only one therapeutically equivalent pangenotypic option without prior authorization may also reflect an effort to balance access with formulary management.
An act to amend Sections 103825, 103835, 103840, 103845, 103850, 103855, 124977, 124991, and 125002 of, and to add Sections 103827 and 103832 to, the Health and Safety Code, relating to public health.