What SB 964 does
An act to add Section 1367.225 to the Health and Safety Code, and to add Section 10123.1934 to the Insurance Code, relating to health care coverage.
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.
Summary from the Legislative Counsel's Digest of the enrolled text, August 27, 2026. Read the full text on leginfo.
How it got here
Senator Smallwood-Cuevas introduced SB 964 on February 3, 2026. The text was amended 3 times, 1 in the Assembly and 2 in the Senate, and heard in 6 committee hearings before its final floor votes.
- Senate Floor, May 19, 2026: 39 ayes, 0 noes.
- Assembly Floor, August 24, 2026: 77 ayes, 0 noes.
- Senate Floor, August 25, 2026: 40 ayes, 0 noes.
Committee votes along the way:
- Senate Health, March 25, 2026: Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations], 11-0.
- Senate Appropriations, April 13, 2026: Placed on suspense file, 7-0.
- Senate Appropriations, May 14, 2026: Do pass as amended, 7-0.
- Assembly Health, June 9, 2026: Do pass and be re-referred to the Committee on [Appropriations], 15-0.
- Assembly Appropriations, August 13, 2026: Do pass., 15-0.
Who supports and opposes SB 964
The Senate Floor Analyses analysis dated August 24, 2026 lists 26 organizations in support and 2 in opposition. When Senate Health first listed positions on March 23, 2026, the count was 12 in support and 2 opposed. By the Senate Floor Analyses analysis of August 24, 2026 it was 26 to 2.
In support: Crohn’s and Colitis Foundation (sponsor); Alliance for Headache Disorders Advocacy; Association of Northern California Oncologists; Bleeding Disorders Council of California; California Academy of Child and Adolescent Psychiatry; California Academy of Family Physicians; California Access Coalition; California Chapter American College of Cardiology; and 18 more.
Opposed: Association of California Life & Health Insurance Companies; California Association of Health Plans.
Read the Senate Floor Analyses analysis.
What happens next
It reached the Governor's desk on August 30, 2026. Bills presented after the Legislature adjourned on August 31 must be signed or vetoed within thirty days.
The Governor can sign the bill, veto it, or let it become law without a signature. Until the decision, sign and veto request letters are the remaining channel, and the Department of Finance's enrolled bill report carries weight on anything with a fiscal effect. If signed, most provisions take effect January 1, and implementation moves to the agencies named in the bill.
What it means for pharmaceutical organizations
Two decisions follow from a bill at this stage. The first is whether to weigh in with the Governor's office before the thirty-day window closes. The second is how to prepare for implementation if it becomes law: which agency writes the rules, when the comment period opens, and which obligations begin January 1.
The pharma group at Capitol Axis handles that for pharmaceutical clients.
Questions about SB 964
What does SB 964 do?
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 p
Has SB 964 passed the California Legislature?
It reached the Governor's desk on August 30, 2026. Bills presented after the Legislature adjourned on August 31 must be signed or vetoed within thirty days.
Who supports and opposes SB 964?
The Senate Floor Analyses analysis dated August 24, 2026 lists 26 organizations in support and 2 in opposition. Supporters include Crohn’s and Colitis Foundation (sponsor); Alliance for Headache Disorders Advocacy; Association of Northern California Oncologists. Opponents include Association of California Life & Health Insurance Companies; California Association of Health Plans.
What happens next with SB 964?
The Governor can sign it, veto it, or let it become law without a signature. Until then, sign and veto request letters are the remaining channel, and the Department of Finance's enrolled bill report carries weight on anything with a fiscal effect.