Bill > AB577

This bill introduces new regulations for health care service plans and health insurers to prevent antisteering practices in prescription medication administration and dispensing, effective January 1, 2026. The bill prohibits health plans, insurers, and pharmacy benefit managers (PBMs) from forcing patients to self-administer medications when a healthcare provider determines in-office administration is medically necessary, requiring patients to use specific pharmacies or infusion centers, or mandating mail-order pharmacy use. It also prevents these entities from imposing higher cost-sharing for in-network medication administration or discriminating against physicians who dispense medications. Healthcare providers must now obtain patient consent and provide a good faith cost estimate before administering injected or infused medications in a different setting than originally directed. The bill applies to both health service plans and health insurance policies, covering scenarios where patients might be steered toward less convenient or potentially more expensive medication administration methods. Additionally, the bill includes specific protections for physicians, such as preventing contract termination based on medication dispensing practices, and establishes clear definitions for terms like "medically necessary" and "dispensing." The legislation aims to give patients and healthcare providers more flexibility and control in prescription medication management while preventing restrictive practices by health plans and PBMs.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB577