SB-40 • 2026

Health care coverage: insulin.

Crime Education

Enacted

This bill passed the Legislature and reached final enactment based on the latest official action.

Sponsor: Wiener (S) , Wahab
Last action: 2025-10-13
Official status: Chaptered by Secretary of State. Chapter 737, Statutes of 2025.
Effective date: Not listed

Plain English Breakdown

The official source material does not provide specific details about what happens when someone needs insulin that is not in Tier 1 or Tier 2, nor how it affects people needing different types of insulin beyond the $35 cap limit.

Health Care Coverage: Insulin

The law limits out-of-pocket costs for insulin to $35 per month starting in 2026 for large groups and 2027 for individuals and small groups, prohibits step therapy as a prerequisite for insulin coverage, and requires at least one type of insulin to be covered by large group plans.

What This Bill Does

Limits the amount a person has to pay for a month's supply of insulin to $35 starting in 2026 for large groups and 2027 for individuals and small groups.
Prohibits health insurance plans from requiring people to try other drugs before getting insulin, unless there is a specific reason.
Requires large group health care plans to include at least one type of insulin in their list of covered medications.

Who It Names or Affects

People with health insurance who need insulin
Health care service plan providers and insurers

Terms To Know

Tiered formulary: A list of medications that are grouped into different levels (tiers) based on cost and effectiveness.
Step therapy: A process where a person must try one or more less expensive drugs before getting the drug they originally needed.

Limits and Unknowns

The law does not specify what happens if someone needs insulin that is not in Tier 1 or Tier 2 for individual and small group plans.
It's unclear how this will affect people who need different types of insulin beyond the $35 cap limit.

Bill History

2025-10-13 California Legislative Information
Chaptered by Secretary of State. Chapter 737, Statutes of 2025.
2025-10-13 California Legislative Information
Approved by the Governor.
2025-09-16 California Legislative Information
Enrolled and presented to the Governor at 3 p.m.
2025-09-09 California Legislative Information
Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2709.) Ordered to engrossing and enrolling.
2025-09-03 California Legislative Information
In Senate. Concurrence in Assembly amendments pending.
2025-09-03 California Legislative Information
Read third time. Passed. (Ayes 79. Noes 0. Page 2865.) Ordered to the Senate.
2025-08-29 California Legislative Information
Ordered to third reading.
2025-08-29 California Legislative Information
Read third time and amended.
2025-08-21 California Legislative Information
Read second time. Ordered to third reading.
2025-08-20 California Legislative Information
From committee: Do pass. (Ayes 15. Noes 0.) (August 20).
2025-07-17 California Legislative Information
Read second time and amended. Re-referred to Com. on APPR.
2025-07-16 California Legislative Information
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (July 15).
2025-06-27 California Legislative Information
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
2025-06-18 California Legislative Information
June 24 hearing postponed by committee.
2025-06-05 California Legislative Information
Referred to Com. on HEALTH.
2025-05-28 California Legislative Information
In Assembly. Read first time. Held at Desk.
2025-05-28 California Legislative Information
Read third time. Passed. (Ayes 37. Noes 0. Page 1280.) Ordered to the Assembly.
2025-05-27 California Legislative Information
Read second time. Ordered to third reading.
2025-05-23 California Legislative Information
Read second time and amended. Ordered to second reading.
2025-05-23 California Legislative Information
From committee: Do pass as amended. (Ayes 6. Noes 0. Page 1189.) (May 23).
2025-05-16 California Legislative Information
Set for hearing May 23.
2025-04-21 California Legislative Information
April 21 hearing: Placed on APPR. suspense file.
2025-04-08 California Legislative Information
Set for hearing April 21.
2025-04-07 California Legislative Information
Read second time and amended. Re-referred to Com. on APPR.
2025-04-03 California Legislative Information
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 635.) (April 2).
2025-03-25 California Legislative Information
Set for hearing April 2.
2025-03-17 California Legislative Information
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
2025-01-29 California Legislative Information
Referred to Com. on HEALTH.
2025-01-06 California Legislative Information
Read first time.
2024-12-04 California Legislative Information
From printer. May be acted upon on or after January 3.
2024-12-03 California Legislative Information
Introduced. To Com. on RLS. for assignment. To print.

Official Summary Text

SB 40, Wiener.
Health care coverage: insulin.
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.

Current Bill Text

Read the full stored bill text

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