California Insurance Code

§ 10123.201

INS § 10123.201 Effective Jan 1, 2024Div. 2 · Part 2 · Ch. 1 · Art. 1

Statute text

(a)A policy of health insurance that covers outpatient prescription drugs shall cover medically necessary drugs. The policy may provide for step therapy and prior authorization consistent with Section 1342.7 of the Health and Safety Code and any regulations adopted pursuant to that section.

(b)(1) Commencing January 1, 2017, an insurer shall maintain a pharmacy and therapeutics committee that shall be responsible for developing, maintaining, and overseeing any drug formulary list. If the insurer delegates responsibility for the formulary to any entity, the obligation of the insurer to comply with this part shall not be waived.

(2)The pharmacy and therapeutics committee board membership shall conform with both of the following:

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Legislative history

Amended by Stats. 2023, Ch. 495, Sec. 2. (SB 621) Effective January 1, 2024.