Bill > SB40

This bill aims to reduce the financial burden of insulin for Californians with diabetes by limiting cost-sharing for insulin prescription drugs across health care service plans and health insurance policies. Starting January 1, 2026, for large group plans and January 1, 2027, for individual and small group plans, the bill caps out-of-pocket costs at $35 for a 30-day supply of insulin, with specific provisions for tiered drug formularies. The bill also prohibits step therapy (a process that requires patients to try less expensive drugs before covering more expensive ones) as a prerequisite for insulin coverage, ensuring that at least one insulin type in each drug category will be available without additional barriers. The legislation is motivated by alarming statistics, including that approximately 4,037,000 California adults have diabetes, one in four insulin users have reported underusing insulin due to high costs, and insulin prices have nearly tripled. By mandating these cost protections, the bill seeks to improve access to a critical medication that is essential for diabetes management and preventing serious health complications. The bill applies to most health plans except for specific types like vision-only or dental-only insurance, and it includes provisions to ensure that the cost limitations do not reduce overall coverage for diabetes-related medical supplies and services.

Budget and Finance, Health and Social Services

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260SB40