SB 1199: Prescription drug cost sharing.

Official summary

Legislative Counsel’s Digest (official, as of the latest version). Written by nonpartisan legislative staff; reproduced verbatim.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law, except as provided and under certain circumstances, prohibits a person who manufactures a prescription drug from offering a discount, repayment, product voucher, or other reduction in an individual’s out-of-pocket expenses associated with their health insurance or health care service plan. Existing law generally imposes specified cost sharing limits on covered prescription drugs.

This bill would require a health care service plan or health insurer, when calculating an enrollee’s or insured’s overall contribution to an out-of-pocket maximum or cost sharing requirement under the plan contract or insurance policy, to count any amount paid by the enrollee or insured or on behalf of the enrollee or insured for a covered drug toward the enrollee’s or insured’s cost sharing, except as provided. The bill would prescribe an administrative penalty for each violation by a health insurer that is enforceable by the Insurance Commissioner after appropriate notice and opportunity for hearing. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Sponsors

Sponsors by party (alphabetical): Democratic 1

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. August 13, 2026August 13 hearing: Held in committee and under submission.
2. August 5, 2026August 5 set for first hearing. Placed on suspense file.
3. July 2, 2026Read second time and amended. Re-referred to Com. on APPR.
4. July 1, 2026From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 13. Noes 0.) (June 30).
5. June 1, 2026Referred to Com. on HEALTH.
6. May 22, 2026In Assembly. Read first time. Held at Desk.
7. May 22, 2026Read third time. Passed. (Ayes 26. Noes 0. Page 4413.) Ordered to the Assembly.
8. May 14, 2026Read second time. Ordered to third reading.
9. May 14, 2026From committee: Do pass. (Ayes 5. Noes 0. Page 4268.) (May 14).
10. May 8, 2026Set for hearing May 14.
11. May 4, 2026May 4 hearing: Placed on APPR. suspense file.
12. April 28, 2026Set for hearing May 4.