California Health and Safety Code

§ 1367.2075

HSC § 1367.2075 Effective Jan 1, 2026Div. 2 · Ch. 2.2 · Art. 5

Statute text

(a)A health care service plan contract issued, amended, or renewed on or after January 1, 2026, that provides prescription drug coverage shall not calculate an enrollee’s cost sharing at an amount that exceeds the actual rate paid by the plan for the prescription drug, and shall include cost-sharing provisions consistent with Section 4079 of the Business and Professions Code. Cost sharing shall include deductibles and copayments.

(b)To the extent that a health care service plan contract with a pharmacy benefit manager issued, amended, or renewed on or after January 1, 2026, includes disclosure on the net price paid by the pharmacy benefit manager or group purchasing organization, then an enrollee’s cost share shall not be calculated at an amount that exceeds that net price paid.

(c)(1) Commencing January 1, 2026, if a preexisting contract between a pharmacy benefit manager licensed pursuant to Article 6.1 (commencing with Section 1385.001) and a health care service plan authorizes spread pricing, as that term is defined by Section 1385.001, any subsequent amendment or renewal of that contract shall not authorize spread pricing.

…

Legislative history

Added by Stats. 2025, Ch. 605, Sec. 2. (SB 41) Effective January 1, 2026.