California § 1367.2075. 1367.2075. (Added by Stats. 2025, Ch. 605, Sec. 2.)

California Statutes

§ 1367.2075. — 1367.2075. (Added by Stats. 2025, Ch. 605, Sec. 2.)

California·Code HSC Health and Safety Code - HSC·Div. 2. DIVISION 2. LICENSING PROVISIONS·Ch. 2.2. CHAPTER 2.2. Health Care Service Plans·Art. 5. ARTICLE 5. Standards

(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

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(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.
(2)
A contract that is executed on or after January 1, 2026, between a pharmacy benefit manager licensed pursuant to Article 6.1 (commencing with Section 1385.001) and a health care service plan shall not authorize spread pricing, as that term is defined by Section 1385.001.

California § 1367.2075. (1367.2075. (Added by Stats. 2025, Ch. 605, Sec. 2.)) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.