Author seeks 30‑day prior‑authorization deadline for rare‑disease treatments

Assemblymember Ziburr introduced AB 18 87, saying the bill would "help reduce unnecessary barriers that delay or interrupt access to life‑saving and life‑altering treatments for Californians living with rare diseases." The measure would require insurers to complete prior‑authorization reviews for prescribed rare‑disease treatments within 30 days and deem requests approved if the deadline is missed. Ziburr told the committee the change targets situations where there is only one FDA‑approved therapy and that the 30‑day window balances insurer review capacity with urgent patient needs.

Patients and clinicians described concrete harms that can follow delays. Isabel Bueno, who said she was born with mucopolysaccharidosis type VI and receives weekly infusions, told the committee that "my doctor know my condition best, and their judgment should not be overruled by an insurance reviewer," and urged the panel to approve the bill. Pediatric clinician Rebecca Sponberg said prior‑authorization delays have prolonged hospital stays, delayed initiation of newly approved drugs and in some cases contributed to serious adverse events; she asked the committee to consider an amendment exempting children under 18 from prior authorization requirements.

Health‑plan witnesses raised process and cost concerns. Cassidy Heckman of the California Association of Health Plans said plans already operate under statutory response timelines (often 72 hours for drugs) and warned that automatically deeming requests approved after 30 days could allow incomplete submissions to become certified as approved requests. She also flagged the potential for very expensive single‑dose biologics to raise market equity and fraud risks if preferential automatic approval were codified.

Ziburr said the bill limits the deemed‑approved mechanism to narrow circumstances—FDA‑approved drugs for rare diseases without interchangeable alternatives and prescribed by specialists—and said the 30‑day approach replaced an earlier, broader waiver in order to give plans time to process complex requests. The committee did not take a vote due to lack of quorum; members said they would act when the committee is fully convened.