Bill > SB40

This bill addresses the high cost of insulin for diabetic patients in California by implementing several key provisions for health care service plans and health insurance policies. Starting in January 2026 for large group plans and January 2027 for individual and small group plans, the bill caps the out-of-pocket cost for a 30-day supply of insulin at $35, regardless of the type of insulin needed. For plans with tiered drug formularies, the $35 cap will only apply to Tier 1 and Tier 2 insulin, with at least one insulin type in each drug category (such as rapid-acting, long-acting) required to be available without additional cost-sharing. The bill also prohibits health care plans from implementing step therapy (a process requiring patients to try less expensive drugs first) as a prerequisite for insulin coverage, ensuring that patients can access the most appropriate insulin for their medical needs. The legislation is motivated by the fact that approximately 4 million California adults have diabetes, insulin prices have nearly tripled, and one in four insulin users have reported underusing the medication due to high costs. By limiting out-of-pocket expenses, the bill aims to improve access to this life-sustaining medication and help prevent diabetes-related complications.

Budget and Finance, Health and Social Services

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