CA SB 964
enactedPrescription drug coverage: dose adjustments.
California · 2025-2026 Regular Session · upper
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Quick answers
Did CA SB 964 pass?
Yes. CA SB 964 has been enacted into law. Latest recorded action (2026-09-27): Chaptered by Secretary of State. Chapter 663, Statutes of 2026.
What is CA SB 964 about?
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified. This bill would authorize an enrollee's or insured's treating contracting provider to submit a written request to a health care service plan or health insurer requesting the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee or insured without prior authorization or subsequent utilization management. The bill would require the plan or insurer to issue a written response within 72 hours and to authorize the request if specified conditions are established in the request. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
Who sponsors CA SB 964?
Smallwood-Cuevas is the primary sponsor of CA SB 964.
Description
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law generally authorizes a health care service plan or health insurer to use utilization review, under which a licensed physician or a licensed health care professional who is competent to evaluate specific clinical issues may approve, modify, delay, or deny requests for health care services based on medical necessity. Existing law also prohibits a health care service plan that covers prescription drug benefits from limiting or excluding coverage for a drug that was previously approved for coverage if an enrollee continues to be prescribed that drug, as specified. This bill would authorize an enrollee's or insured's treating contracting provider to submit a written request to a health care service plan or health insurer requesting the authority to adjust the dose or frequency of a drug to meet the specific medical needs of the enrollee or insured without prior authorization or subsequent utilization management. The bill would require the plan or insurer to issue a written response within 72 hours and to authorize the request if specified conditions are established in the request. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.
- Introduced
- 2026-02-03
- Latest action
- 2026-09-27 — Chaptered by Secretary of State. Chapter 663, Statutes of 2026.
- Bill type
- bill
- Last updated
- —
Subjects
Sponsors
- Smallwood-Cuevasauthor
Committees
Not provided by source.
Action timeline
Newest first
2026-09-27
Chaptered by Secretary of State. Chapter 663, Statutes of 2026.
became-law
2026-09-27
Approved by the Governor.
executive-signature
2026-08-30
Enrolled and presented to the Governor at 6 p.m.
2026-08-25
Assembly amendments concurred in. (Ayes 40. Noes 0.) Ordered to engrossing and enrolling.
amendment-passage,committee-passage,committee-passage-favorable
2026-08-25
Assembly amendments concurred in. (Ayes 40. Noes 0. Page 5740.) Ordered to engrossing and enrolling.
2026-08-24
Read third time. Passed. Ordered to the Senate.
passage,reading-1,reading-3
2026-08-24
In Senate. Concurrence in Assembly amendments pending.
2026-08-24
Read third time. Passed. (Ayes 77. Noes 0. Page 6390.) Ordered to the Senate.
passage,reading-1,reading-3
2026-08-17
Ordered to third reading.
reading-1,reading-3
2026-08-17
Read third time and amended.
amendment-passage,reading-1,reading-3
2026-08-13
Read second time. Ordered to third reading.
reading-1,reading-2,reading-3
2026-08-13
Assembly Rule 63 suspended.
2026-08-13
From committee: Do pass. (Ayes 15. Noes 0.) (August 13).
committee-passage,committee-passage-favorable
2026-06-24
June 24 set for first hearing. Placed on suspense file.
2026-06-10
From committee: Do pass and re-refer to Com. on APPR. (Ayes 15. Noes 0.) (June 9). Re-referred to Com. on APPR.
committee-passage,committee-passage-favorable,referral-committee
2026-05-26
Referred to Com. on HEALTH.
referral-committee
2026-05-20
In Assembly. Read first time. Held at Desk.
reading-1
2026-05-19
Read third time. Passed. (Ayes 39. Noes 0. Page 4357.) Ordered to the Assembly.
passage,reading-1,reading-3
2026-05-18
Read second time. Ordered to third reading.
reading-1,reading-2,reading-3
2026-05-14
Read second time and amended. Ordered to second reading.
amendment-passage,reading-1,reading-2
2026-05-14
From committee: Do pass as amended. (Ayes 7. Noes 0. Page 4259.) (May 14).
amendment-passage,committee-passage,committee-passage-favorable
2026-05-08
Set for hearing May 14.
2026-04-13
April 13 hearing: Placed on APPR. suspense file.
2026-04-10
Set for hearing April 13.
2026-04-06
Read second time and amended. Re-referred to Com. on APPR.
amendment-passage,reading-1,reading-2,referral-committee
2026-03-26
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 3689.) (March 25).
amendment-passage,committee-passage,committee-passage-favorable,referral-committee
2026-03-09
Set for hearing March 25.
2026-02-11
Referred to Com. on HEALTH.
referral-committee
2026-02-04
From printer. May be acted upon on or after March 6.
2026-02-03
Introduced. Read first time. To Com. on RLS. for assignment. To print.
introduction,reading-1,referral-committee
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Votes
Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]
2026-03-25 · pass · 11-0
Member-level votes (11)
- Menjivar: yes
- Gonzalez: yes
- Pérez: yes
- Smallwood-Cuevas: yes
- Rubio: yes
- Weber Pierson: yes
- Grove: yes
- Padilla: yes
- Durazo: yes
- Caballero: yes
- Valladares: yes
Placed on suspense file
2026-04-13 · pass · 7-0
Member-level votes (7)
- Dahle: yes
- Richardson: yes
- Cervantes: yes
- Cabaldon: yes
- Seyarto: yes
- Wahab: yes
- Grayson: yes
Do pass as amended
2026-05-14 · pass · 7-0
Member-level votes (7)
- Cervantes: yes
- Seyarto: yes
- Wahab: yes
- Cabaldon: yes
- Dahle: yes
- Richardson: yes
- Grayson: yes
3rd Reading SB964 Smallwood-Cuevas
2026-05-19 · pass · 39-0
Member-level votes (40)
- Weber Pierson: yes
- Allen: yes
- Cortese: yes
- Hurtado: yes
- Ochoa Bogh: yes
- Wiener: yes
- Limón: yes
- Grayson: yes
- Becker: yes
- Cervantes: yes
- Rubio: yes
- McGuire: yes
- Stern: yes
- Smallwood-Cuevas: yes
- Gonzalez: yes
- Padilla: yes
- Choi: yes
- Durazo: yes
- Cabaldon: yes
- Arreguín: yes
- Strickland: yes
- Umberg: yes
- Alvarado-Gil: yes
- Ashby: yes
- Menjivar: yes
- Jones: yes
- Laird: yes
- Valladares: yes
- Blakespear: yes
- Archuleta: yes
- Richardson: yes
- McNerney: yes
- Pérez: yes
- Caballero: yes
- Dahle: yes
- Reyes: yes
- Grove: yes
- Wahab: yes
- Seyarto: yes
- Niello: other
Do pass and be re-referred to the Committee on [Appropriations]
2026-06-09 · pass · 15-0
Member-level votes (16)
- Stefani: yes
- Patterson: yes
- Johnson: yes
- Carrillo: yes
- Chen: yes
- Sanchez: yes
- Sharp-Collins: yes
- Bonta: yes
- Ahrens: yes
- Elhawary: yes
- Addis: yes
- Caloza: yes
- Celeste Rodriguez: yes
- Aguiar-Curry: yes
- Patel: yes
- Schiavo: other
Related bills
No related bills recorded for this bill.
Official source
Attribution
Data from openstates_api_sync, retrieved 2026-09-30T03:29:16.539363Z
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