Bill > SB40

This bill aims to reduce the financial burden of insulin for Californians by implementing several key provisions for health care service plans and health insurance policies starting January 1, 2026. The bill would limit copayments, coinsurance, deductibles, and other cost-sharing for insulin prescriptions to no more than $35 for a 30-day supply, with specific considerations for drug formulary tiers and high-deductible health plans. Additionally, the bill prohibits health care service plans and insurers from imposing step therapy (a process that requires trying less expensive medications before approving a specific drug) as a prerequisite for insulin coverage, with the caveat that at least one insulin in each drug type must be covered without step therapy. The legislation is motivated by the high prevalence of diabetes in California, with approximately 4,037,000 adults diagnosed, and the increasing cost of insulin that has led to one in four insulin users reporting underuse due to financial constraints. The bill also requires coverage for diabetes outpatient self-management training and education, and it explicitly states that insurers cannot reduce or eliminate existing coverage as a result of these new requirements. Notably, the bill applies to both individual and small group health care plans and insurance policies, with slightly different implementation dates for different market segments.

Budget and Finance, Health and Social Services

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