CommercialCoverageMedium impact
24-1220m Find Out How AB 948 Affects Tiers on the Drug List
Health Net·CA·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
California Assembly Bill 948 introduces new drug formulary tier definitions effective January 1, 2025, which may change member copays for prescription drugs. The bill establishes a $250 maximum copay for essential health drugs for a 30-day supply and requires the lowest cost-sharing for generic equivalents regardless of formulary inclusion.
Action Required
By January 1, 2025: Billing team should review the new 4-tier drug formulary definitions to understand potential member copay changes. Update patient communication processes to address copay inquiries based on new tier classifications. Monitor for member questions about drug copay changes that were communicated by Health Net starting November 1, 2024.