CaliforniaHealth care coverage: insulin.
What it does
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.
More detail
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.
Where do you stand?
Choose your position
Tell your reps
Take a position to see your representatives and ways to contact them.
Where it stands
- Introduced
- Passed Senate
- Passed Assembly
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2025
- Oct 13Chaptered by Secretary of State. Chapter 737, Statutes of 2025.Latest
- Oct 13Approved by the Governor Gavin Newsom.Became Law
- Sep 16Enrolled and presented to the Governor at 3 p.m.To Governor
- Sep 9Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2709.) Ordered to engrossing and enrolling.Major
- Vote recorded Unfinished Business SB40 Wiener et al. Concurrence. Result: pass.Upper
- Sep 3In Senate. Concurrence in Assembly amendments pending.
- Vote recorded SB 40 Wiener Senate Third Reading By Bains. Result: pass.Lower
- Sep 3Read third time. Passed. (Ayes 79. Noes 0. Page 2865.) Ordered to the Senate.Passed Assembly
- Aug 29Ordered to third reading.Minor
- Aug 29Read third time and amended.Major
- Aug 21Read second time. Ordered to third reading.Minor
- Aug 20From committee: Do pass. (Ayes 15. Noes 0.) (August 20).Minor
- Vote recorded Do pass. Result: pass.Lower
- Jul 17Read second time and amended. Re-referred to Com. on APPR.Major
- Jul 16From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (July 15).Major
- Jul 15
- Vote recorded Do pass as amended and be re-referred to the Committee on [Appropriations]. Result: pass.Lower
- Jun 27From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.Major
- Jun 18June 24 hearing postponed by committee.
- Jun 5Referred to Com. on HEALTH.Minor
- May 28In Assembly. Read first time. Held at Desk.Minor
- Vote recorded 3rd Reading SB40 Wiener et al. Result: pass.Upper
- May 28Read third time. Passed. (Ayes 37. Noes 0. Page 1280.) Ordered to the Assembly.Passed Senate
- May 27Read second time. Ordered to third reading.Minor
- May 23Read second time and amended. Ordered to second reading.Major
- Vote recorded Do pass as amended. Result: pass.Upper
- May 23From committee: Do pass as amended. (Ayes 6. Noes 0. Page 1189.) (May 23).Major
- May 16Set for hearing May 23.
- Apr 21April 21 hearing: Placed on APPR. suspense file.
- Vote recorded Placed on suspense file. Result: pass.Upper
- Apr 8Set for hearing April 21.
- Apr 7Read second time and amended. Re-referred to Com. on APPR.Major
- Apr 3From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 635.) (April 2).Major
- Apr 2
- Vote recorded Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations]. Result: pass.Upper
- Mar 25Set for hearing April 2.
- Mar 17From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.Major
- Jan 29Referred to Com. on HEALTH.Minor
- Jan 6Read first time.Minor
- 2024
- Dec 4From printer. May be acted upon on or after January 3.
- Dec 3Introduced. To Com. on RLS. for assignment. To print.Introduced