AB 1887 ensures faster access to lifesaving treatments by eliminating prior authorization and step therapy requirements for FDA-approved rare disease therapies.
SACRAMENTO, CA – Democratic Caucus Chair and Assemblymember Rick Chavez Zbur (D–Hollywood) today introduced AB 1887, legislation to remove unnecessary insurance barriers that delay or interrupt access to lifesaving and life-altering treatments for Californians living with rare diseases. Sponsored by the California Chronic Care Coalition, this bill eliminates prior authorization and step therapy requirements for FDA-approved rare disease treatments when prescribed by an appropriate specialist based on medical necessity—ensuring patients can access care without avoidable delays.
"Families facing rare diseases have already waited years for a diagnosis and a viable treatment," said Assemblymember Zbur. "Delaying care further—when a therapy is FDA-approved and prescribed by a specialist—is not only unnecessary, but reckless, and in some cases can amount to a death sentence. AB 1887 restores medical decision-making to doctors and gets lifesaving care to patients when they need it most."
Rare diseases are a critical public health issue affecting an estimated 1 in 10 Californians and impose devastating human and economic costs. Patients often wait 7 to 8 years for a diagnosis, delaying care long before insurance barriers even begin. Many of these conditions are lifelong and life-threatening, and one-third of children born with a rare disease die before age five due to a lack of access to timely treatment.
Prior authorization—originally intended as a cost-control tool—has proven particularly harmful for rare disease patients. Because rare disease therapies are often the only effective option, insurer requirements to "try and fail" alternative treatments are frequently irrelevant and dangerous. In addition, insurers and third-party reviewers often lack expertise in rare conditions, leading to repeated denials and prolonged delays, some of which have ended in hospitalization, permanent disability, and even death, according to the American Medical Association's (AMA) 2021 Prior Authorization Physician's Survey.
"The California Chronic Care Coalition strongly supports Assemblymember Zbur's legislation. Patients living with rare diseases cannot afford dangerous delays caused by prior authorization and step therapy when their physicians have already determined what treatment is medically necessary," said Liz Helms, President and CEO of the California Chronic Care Coalition. "By prohibiting health plans from blocking access to FDA-approved rare disease medications when no generic or biosimilar alternative exists, this bill puts medical decisions back in the hands of patients and their clinicians and helps ensure that Californians with rare and complex conditions get timely, appropriate care instead of being forced to 'fail first' on ineffective therapies."
Eliminating prior authorization for rare disease therapies has minimal impact on insurer finances while significantly reducing downstream medical costs and preventable complications. AB 1887 also builds on successful reforms already enacted in California, including the elimination of prior authorization for HIV prevention medications, and aligns with similar policies and reforms enacted in states like New Mexico. As a global leader in rare disease research and innovation, California must also lead in ensuring patients can access the therapies developed here.
Assemblymember Rick Chavez Zbur serves as the Democratic Caucus Chair for the California State Assembly and represents the 51st Assembly District, which includes Universal City, Hollywood, Hancock Park, West Hollywood, Beverly Hills, Westwood, West Los Angeles, Santa Monica, and other portions of Los Angeles.
CONTACT: Vienna Montague, (916) 319-2051, Vienna.Montague@asm.ca.gov