Committee advances bill letting clinicians make limited medication dose adjustments without new prior authorization

Author sponsors told the panel that SB 964 is intended to protect continuity of care for patients with chronic and complex conditions by allowing clinicians to make up to two clinically appropriate dose or frequency adjustments for a covered medication without requesting a new prior authorization.

Dr. Archana Linganen, a pediatric gastroenterologist at Valley Children’s Hospital, said prior authorization delays can force use of inferior or riskier treatments and can push patients to emergency care. "A denial forces us to add steroids or older, riskier medications with more side effects," she told the committee, describing inflammatory bowel disease care where timely dose changes are important to avoid loss of response to a drug.

Opponents from plan associations asked the committee to amend the bill to require conformity with FDA labeling and to preserve utilization‑management safeguards. Olga Shiloh of the California Association of Health Plans said removing review authority could raise patient‑safety and cost concerns when dose changes exceed tested or approved dosing.

The bill’s author and sponsors said they would continue negotiations with opponents and that the proposal includes safeguards: off‑label uses would need supporting literature (two peer‑reviewed articles) when those uses are proposed.

The committee advanced SB 964 to the next committee with a motion and recorded roll call.

What's next: SB 964 will move to the indicated committee for further review and possible amendments before floor consideration.