MedCentralNew Calif. Prior Authorization Law to Take Effect in 2028

California’s SB 306 requires health insurers to eliminate prior authorization for any service they have approved 90% or more of the time, effective January 2028. The law shifts the burden of proof from clinicians to insurers, inverting the gold card model used in Texas and other states.

Why It Matters

• NPs and PAs average 39 prior authorization requests per week, consuming roughly 13 hours of staff time according to a 2024 AMA survey of 1,000 physicians.
• California’s approach is structurally distinct from gold card programs: clinicians do not need to earn exemption status, insurers must justify continued use of prior auth through published data.
• The 90% approval threshold means services rubber-stamped by insurers anyway will no longer require submission, directly reducing administrative volume for high-frequency prescribers.
• Prior auth can be reinstated under the law if fraud, clinical inappropriateness, or inconsistent care patterns are identified, preserving insurer leverage in edge cases.

What to Watch

• California publishes its list of exempt services by July 1, 2027: NPs and PAs in the state should monitor which high-volume services clear the threshold.
• Washington state SB 5395 adds guardrails on AI-driven prior authorization decisions; South Dakota HB 1199 requires insurer transparency reporting. A multistate trend is building.
• Insurer lobbying pushed for a 95% threshold during SB 306 negotiations; expect similar resistance in other states as this model spreads.

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