Amendments and Analysis Updates

Bill Amended – 1/05/2026 – CHBRP provided an updated analysis on January 7, 2026. All portions of CHBRP's analysis remain relevant.

Bill amended – 8/20/2026 – The August 20th amendments align language with other bills under consideration. Amended language states that commercial/CalPERS plans and policies that provide coverage for the application of fluoride varnish as a pediatric oral care benefit must cover the benefit without cost sharing whether the service is billed as medical or dental benefit. Amendments also add language exempting plans and policies required to cover Essential Health Benefits (EHBs) if this benefit is determined to exceed EHBs and require defrayal. For Medi-Cal, amendments require the Department of Health Care Services to issue billing guidance that includes the application of fluoride or other appropriate fluoride treatment for children under 21 years of age without any place of service restrictions, and ensures policy is consistent with the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. 

The estimates for Medi-Cal provided in CHBRP’s analysis are still relevant; the estimates for enrollees in commercial/CalPERS plans and policies would likely be lower because amended language does not require coverage of fluoride varnish for all enrollees under age 21 years of age and does not require coverage for plans and policies that currently do not provide coverage of fluoride varnish. All other portions of CHBRP's analysis remain relevant.

Bill amended – 9/05/2025 – Amended language modifies the language regarding continuing medical education. The July amendments narrow the scope of the bill to only outpatient prescription medications covered under a state-regulated pharmacy benefit, which would remove the impacts to medications covered under the medical benefit. 

These changes would result in a small decrease in estimated impacts for commercial and CalPERS plans and an elimination of impacts for Medi-Cal managed care plans and County Organized Health Systems. The August amendments explicitly exempt Medi-Cal managed care plans from complying with AB 432. All other portions of CHBRP's analysis remain relevant.

Bill amended – 9/03/2025 – Amended language would narrow the bill requirements to include coverage for only one HEPA purifier, under $500. The amendments also remove the prohibition on cost sharing, and limit eligibility for the benefit to only enrollees with health plans or policies in the large group market who are located in counties where a local or state emergency has been declared due to wildfires, and have a prescription for a HEPA purifier from their health care provider. The amended language would also require health plans/insurers to notify enrollees affected by a local or state emergency declaration due to wildfire of the benefit within 30 days of the declaration. 

The background and medical effectiveness sections of CHBRP’s analysis related to HEPA purifiers remain relevant. The amendments would increase administrative costs as a result of the notification mandate. Utilization of the benefit may decrease due to the requirement for a prescription, which would result in a corresponding decrease in fiscal impact.

Bill amended – 9/04/2025 – Amended language removes the staggered implementation, which would shift associated projected cost impacts from Year 2 to Year 1. Amended language narrows the mandate to require coverage without cost sharing for only preexposure prophylaxis under nongrandfathered plans. Because coverage for preexposure prophylaxis is already required under the California and Federal Preventive Service Acts, the bill would have no impact on these plans. The amendments would result in a decrease in the projected fiscal impact from CHBRP’s analysis. 

In addition, amended language defines a long-acting drug, drug device, or drug product as not therapeutically equivalent to a long-acting drug, drug device, or drug product with a different duration. Although there are currently a limited number of antiretroviral drugs formulated with the same ingredients but with different durations, there are extended duration formulations of antiretroviral drugs in development. In the long-term, if these developments are successful, the amended language would prohibit these extended duration formulations from being subject to prior authorization and step therapy and would increase the fiscal impact of the bill. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 8/29/2025 – The amendments were small technical changes, and CHBRP's initial analysis and the 8/1/25 updated cost analysis remain relevant. Previous amended language from 7/15 reduces the timeframe during which visits would be covered (during the state of emergency), specifies coverage would be for up to 12 visits total, expands coverage to include a wildfire that reaches beyond a single county, and requires that the enrollee has experienced a loss, trauma, or displacement because of the fire. 

These and previous amendments would result in net reductions in populations covered and costs, as reflected in CHBRP’s 8/1/25 updated cost analysis. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 4/09/2026 – Amendments remove “other clinically indicated diagnostic testing” as part of the definition of diagnostic breast imaging and “tests for screening or diagnostic purposes.” 

Per CHBRP’s assumed definitions of these terms, all portions of CHBRP’s analysis remain relevant. However, regulators may interpret these changes to mean that biopsy and pathology evaluation are no longer within scope for AB 1570; in this case, the fiscal impact of the bill would decrease.

Bill amended – 8/21/2026 – Amendments limits the bill’s scope to large group plans and Medicaid. The amended language clarifies that, for Medi-Cal, scalp cooling may be subject to utilization management and medical necessity requirements. 

These amendments would reduce the number of enrollees in plans or policies subject to the bill, and therefore reduce the fiscal impact compared to estimates in the original CHBRP analysis. Since the number of enrollees in health plans and policies required to be compliant with the bill would be reduced under the amended language, the public health impact may also be lower than estimated in the original CHBRP analysis. The analysis of medical effectiveness in the CHBRP analysis and the background information remain relevant.

Bill amended – 8/26/2026 – Amendments remove the requirement for prior authorization practices to align with current clinical guidelines. Previous amendments state that if one or more therapeutic equivalents of a pangenotypic medication are FDA-approved, plans and policies are required to cover one without prior authorization. Amendments make other clarifying changes to the bill language. 

To the extent coverage requirements for treatments for hepatitis C would align current clinical guidelines postmandate, all portions of CHBRP’s analysis remain relevant.

Bill amended – 8/21/2026 – Amendments limit the bill‘s scope to drugs that are the sole FDA-approved treatment for a given rare disease. Amendments require health plans and insurers to complete prior authorization reviews within 30 days of the initial request, after which unresolved requests are automatically approved. This requirement no longer applies to step therapy or other forms of utilization review, nor does it exclude drugs with a biosimilar, interchangeable biologic, or generic version available. 

While these changes would reduce the bill’s fiscal impact compared to CHBRP’s original analysis, they would likely delay access to prescription drugs. These delays could match or exceed current wait times, which would limit or reduce health and qualify-of-life improvements at the person-level projected by CHBRP in its original analysis. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 8/21/2026. August 21st amendments require that health plans and policies cover self-collected tests for cervical cancer screening consistent with relevant recommendations pursuant to section 120164 of the Health and Safety Code (HSC), as opposed to nationally recognized clinical guidelines. As established by AB 144 of 2025, HSC section 120164 gives the California Department of Public Health (CDPH) the authority to modify or supplement baseline recommendations for preventive services required to be covered without cost sharing. In July 2026, in accordance with this section, CDPH added a supplemental recommendation for self-collected hrHPV testing for people age 30 to 65 years. This amendment shifts CHBRP’s estimated fiscal impact of AB 1906, as the cost of this bill would be absorbed by existing law, but does not likely impact the magnitude of the estimate. 

Amendments also revise the Welfare and Institutions code to require that Medi-Cal reimbursement for a test relevant to the bill must use a clinically appropriate CPT or HCPCS billing code to comply with HIPAA. Additional amendments make other clarifying changes to the bill language. 

Previous amendments removed the requirement of coverage for an annual cervical cancer screening test; specified that self-collected test kits must be FDA authorized or cleared and that they allow self-collection at a location outside of a clinical setting; and specified that AB 1906 would not limit the application of the preventive services mandate. 

CHBRP’s cost estimates are impacted per the description above. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 6/29/2026 - Amended language states that if there is more than one therapeutic or clinical equivalent approved by the FDA, plans or policies would not be required to cover all therapeutic or clinical equivalents without step therapy if at least one therapeutic or clinical equivalent is available without step therapy. CHBRP’s carrier survey results showed that some plans and policies listed a drug as subject to step therapy when there is one or more FDA-approved equivalent(s) not subject to step therapy requirements. 

With the bill’s amended language, it is likely that fewer individuals would have coverage subject to the bill. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 8/29/2025 – The amendments would result in minimal differences compared with CHBRP's estimate of SB 40 as introduced. Estimated expenditure impacts in the small group and individual markets would be delayed by one year and differences would exist based on the number of enrollees in these markets in 2027 as compared with the estimated population in 2026. Additionally, the amendment that limits the cost sharing cap to insulins placed on Tier 1 and Tier 2 could result in some enrollees experiencing cost sharing above the $35 copay cap and therefore would decrease the estimated fiscal estimates included in CHBRP’s analysis. However, it is likely the requirements pertaining to which insulins must be covered on Tier 1 and Tier 2 would capture a large majority of the insulins enrollees use. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 5/05/2025 – The bill amendment moves away from “attained age" to "age at issue" (which is another popular way to set premiums in this market). CHBRP anticipates the amended language would result in a smaller but still significant premium increase because there would be a barrier to enrollment in Medicare Supplement plans for older beneficiaries - it would not be as worthwhile for beneficiaries to wait until they are older. However, the guaranteed issue provision remaining in SB 242 would still cause some people to choose to wait to purchase Medicare Supplement plans. 

The amended language would likely reduce adverse selection, which in turn should reduce the magnitude of premium increases and thus increase enrollment of lower risk, less costly individuals.

Bill amended – 9/04/2025 – Amendments rename the bill “PARENT Act” and remove all language prohibiting health plans and policies from seeking reimbursement for maternity services or newborn and pediatric care services because the enrollee is acting as a gestational carrier. Amendments also remove language prohibiting health plans and policies from denying coverage or otherwise discriminating against an enrollee, their newborn, or their health care provider. 

Portions of CHBRP’s introduction, background, medical effectiveness, and public health sections remain relevant. Portions of CHBRP’s analysis pertaining to gestational carriers are no longer relevant.

Bill amended – 8/19/2026 – Amendments delay the bill’s effective date to 2028 (previously 2027) and shift the requirements of coverage from a mandatory to a permissive cap. Additionally, amendments introduce an allowable 10% coinsurance. This impacts CHBRP’s fiscal and coverage estimates. Amendments would likely reduce CHBRP’s previously estimated decrease in enrollee out-of-pocket expenses and reduce the magnitude of premium increase due to CHBRP’s price sensitivity assumptions. All other portions of CHBRP’s analysis (background and policy context) remain relevant.

Bill amended – 9/05/2025 – Amendments add language requiring that health plans and policies arrange for a prescription hormone therapy to be provided by an out-of-network provider when the prescription for a medically necessary hormone therapy is unavailable within network. Amendments also remove language prohibiting health plans and policies from requiring an enrollee to make a formal request for coverage other than a pharmacy claim. Amended language clarifies that SB 418 excludes glucagon-like peptide-1 and glucagon-like peptide-1 receptor agonists. Amendments to Section 7 remove language prohibiting the use of utilization management controls for the Medi-Cal program, clarify that the section only applies to the maximum supply allowed under state and federal law for controlled substances, and requires that the department receive federal approval for implementing this coverage for Medi-Cal enrollees. Finally, amendments remove explanation of the Section 9 urgency clause. 

While all portions of CHBRP’s analysis remain relevant, changes to the utilization management and Medi-Cal requirements of the bill likely impact CHBRP’s cost analysis.

Bill amended – 7/17/2025 – Amended language strikes all bill provisions under the California Insurance Code, thereby removing all of the bill’s previous mandates on CDI-regulated plans. In addition, the amendments remove the mandate for DMHC-regulated plans to cover intensive behavioral therapy, and clarify that such plans must abide by existing state regulations pertaining to prescription outpatient drugs. The amendments would reduce CHBRP’s fiscal projections of the bill. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 7/17/2025 – Amended language would define a health care practitioner for the purposes of the bill and add language allowing a referral to another qualified provider to constitute a health care practitioner’s satisfaction of the bill requirement to screen a patient for a perinatal mental health condition. Amended language would also encourage but no longer require health plans and policies to improve screening and treatment for perinatal mental health conditions through the use of medications and digital therapeutics approved by the FDA for perinatal mental health conditions. Amended language would also allow providers to adhere to guidelines or standards adopted by other recognized professional bodies if adherence to ACOG clinical guidelines does not align with a provider’s scope of practice. 

The background and medical effectiveness sections of CHBRP’s analysis remain relevant.

Bill amended – 8/19/2026 – The August 19th amendments change language that would require coverage of FDA-approved treatments for Alzheimer’s disease or other related dementia to Alzheimer’s disease or other medical conditions affecting memory. There are no other specific treatments for other types of dementia, apart from vascular dementia, which can be treated with statins and blood pressure medications and are already covered. There may be treatments in the future for non-Alzheimer's dementias, but as of now, CHBRP estimates this language change would not increase coverage. Previous amendments clarify that SB 950 would only require coverage of relevant prescription medications within plans and policies that have a pharmacy benefit, removes the requirement for plans and policies to cover non-self-administered treatments under both the medical benefit and the pharmacy benefit, and states that prior authorization requests for medications to treat Alzheimer’s disease shall be considered exigent circumstances. These amendments would result in no enrollees using infusion disease-modifying medications as a covered medication under the pharmacy benefit. As a result, fiscal impacts would be slightly lower than projected in CHBRP’s analysis. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 8/20/2026 – June 18th amendments remove language that would require CalPERS to offer coverage of GLP-1s. August 20th amendments do not have additional impact on requirements for CalPERS plans. CHBRP’s analysis remains relevant for information on background and medical effectiveness of GLP-1s.

Bill amended – 8/19/2026 – Previous amendments removed the authority of health plans and insurers to require an enrollee or insured to try an AB-rated generic equivalent of a brand name drug. The Aug 19th amendments require health plans and policies to cover a lower-cost biosimilar alongside any brand-name reference product on their formularies. The amendments also increase health plan and insurers’ reporting requirements related to formulary changes and mandates to patients to try biosimilars. Finally, the amendments prohibit a health plan, pharmacy benefit manager, or affiliated entity from requiring utilization of only a biosimilar product in which it has a financial interest if other biosimilars with which it is not affiliated are available on the market. 

CHBRP does not anticipate the amendments would significantly alter the fiscal impact of the bill; all portions of CHBRP’s analysis remain relevant.

Bill amended – 7/02/2026 – The amended language clarifies that the bill applies to generic equivalent prescription drugs, interchange biosimilars, and biosimilars. The bill would now also require pharmacies processing claims using assistance to notify the applicable health plan or insurer of financial assistance used for the claim in order for it to count towards the patient’s out-of-pocket maximum. Previous amendments align the bill language with federal rules related to high-deductible health plans. Amendments also allow copay adjustment programs to be implemented for branded prescription drugs during the time period until an FDA-approved therapeutically equivalent version of the drug has been approved for three calendar months; existing law allows drug manufacturer financial assistance during this time. These latter mentioned amendments would reduce the annual fiscal impact of the bill for those drugs to which this provision applies. All other portions of CHBRP’s analysis remain relevant.

Bill amended – 6/18/2026 – Amendments expand upon the clarification that high-deductible health plans that are eligible for a health savings account cannot impose a deductible, coinsurance, or other cost sharing on the services relevant to the bill, unless doing so would conflict with federal rules on high-deductible health plans. This amendment would allow high-deductible health plans that are eligible for health savings accounts to impose a deductible for non-preventative services to the extent required under federal law. Previous amendments specify that the bill does not apply to specialized health care service plan contracts. All portions of CHBRP’s analysis remain relevant.