SB 40: Health care coverage: insulin.

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’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or disability insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits to include coverage for insulin if it is determined to be medically necessary.

This bill would prohibit a large group health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2026, or an individual or small group health care service plan contract or health insurance policy on or after January 1, 2027, from imposing a copayment, coinsurance, deductible, or other cost sharing of more than $35 for a 30-day supply of an insulin prescription drug, except as specified. On and after January 1, 2026, the bill would prohibit a health care service plan or health insurer from imposing step therapy as a prerequisite to authorizing coverage of insulin, and, for a large group health care service plan contract or health insurance policy, would require at least one insulin for a given drug type in all forms and concentrations to be on the prescription drug formulary. The bill would limit the $35 cap for an individual or small group health care service plan contract or health insurance policy to only Tier 1 and Tier 2 insulin if the drug formulary is grouped into tiers, except as provided. 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 6

“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. October 13, 2025Chaptered by Secretary of State. Chapter 737, Statutes of 2025.
2. October 13, 2025Approved by the Governor.
3. September 16, 2025Enrolled and presented to the Governor at 3 p.m.
4. September 9, 2025Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2709.) Ordered to engrossing and enrolling.
5. September 3, 2025In Senate. Concurrence in Assembly amendments pending.
6. September 3, 2025Read third time. Passed. (Ayes 79. Noes 0. Page 2865.) Ordered to the Senate.
7. August 29, 2025Ordered to third reading.
8. August 29, 2025Read third time and amended.
9. August 21, 2025Read second time. Ordered to third reading.
10. August 20, 2025From committee: Do pass. (Ayes 15. Noes 0.) (August 20).
11. July 17, 2025Read second time and amended. Re-referred to Com. on APPR.
12. July 16, 2025From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (July 15).