Health care coverage: insulin.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Chaptered
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed Assembly
- To Governor
- Became Law
Overview
This bill aims to make insulin more affordable for Californians by limiting copays, deductibles, and other cost-sharing for insulin prescriptions. It prohibits large health plans and insurers from imposing excessive costs on insulin, particularly for individuals and small groups. The bill also prohibits step therapy for insulin and requires insurers to include a variety of insulin types on their formularies, with specific caps on costs for certain groups of patients.
Key provisions
- Limits copays, coinsurance, and deductibles for insulin prescriptions to $35 per 30-day supply for large group plans starting in 2026.
- Prohibits step therapy for insulin prescriptions starting in 2026.
- Requires insurers to include at least one insulin option in all drug types on their formularies.
- Caps cost-sharing for individual and small group plans to $35 per 30-day supply starting in 2027.
- Applies the $35 cap to Tier 1 and Tier 2 insulin for individual and small group plans.
- Includes coverage for diabetes outpatient self-management training, education, and medical nutrition therapy.
- Addresses coverage for insulin in disability insurance policies, mirroring provisions in health insurance.
- Provides for state reimbursement for local agencies and school districts due to the creation of a new crime.
Who is affected
- Individuals with diabetes
Bill text
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