💊

Insulin Costs

Before SB 40, insulin copays in California could hit $300 to $500 a month. People rationed a drug they need to survive. The bill, signed into law in October 2025, caps copays at $35 and bans step therapy requirements that forced patients to try cheaper alternatives first. But the actual legislative analysis is a 62-page document full of actuarial tables, Health and Safety Code references, and implementation timelines split across different plan types. A person with diabetes cannot read this document and understand whether they are covered, when the cap takes effect for their plan, or what to do if their insurer does not comply. That is exactly the gap this brief fills.

CaliforniaCalifornia SB 40: Insulin Cost-Sharing and Step Therapy (CHBRP Analysis)

92% High confidence

View original document →

92% High confidence

SB 40 Would Cap Insulin Cost-Sharing at $35 and Ban Step Therapy Requirements

What changed

California Senate Bill 40 would limit cost-sharing (copayments, coinsurance, deductibles) for insulin to $35 for a 30-day supply and prohibit step therapy protocols as a prerequisite to authorizing insulin coverage for state-regulated health insurance plans. The bill has been analyzed by the California Health Benefits Review Program, but no vote count is mentioned in this document.

👤

Who is affected

13.57 million Californians with state-regulated health insurance (commercial and CalPERS plans regulated by DMHC and CDI). Specifically affects 39,178 insulin users (42% of current insulin users) whose current cost-sharing exceeds $35. Excludes Medi-Cal beneficiaries whose pharmacy benefits are administered by the Department of Health Care Services.

✓

What you can do

Not specified in this document - this is an analysis report to the legislature, not a public notice with comment opportunities.

Where the money goes

Would increase total annual expenditures by $2.147 million (0.001%) for affected enrollees. Premium increases would be $10.377 million, but enrollee out-of-pocket costs would decrease by $8.23 million. For affected insulin users, average monthly cost-sharing would drop from $52 to $29. Top 1% of affected users would save more than $1,463 annually.

📚

Context

26 states plus Washington DC already have insulin cost-sharing caps. Previous similar California bills (AB 2203, AB 97, SB 473, SB 90) failed to pass. This builds on federal Medicare Part D insulin caps of $35. California's CalRx initiative aims to produce biosimilar insulin at $30 per vial once FDA approved.

“There is strong evidence that cost sharing affects insulin use and adherence in patients with diabetes; higher cost sharing reduces adherence, and lower cost sharing increases adherence.”

“In 2026, of the 22.2 million Californians enrolled in state-regulated health insurance, 13.57 million of them would have insurance subject to SB 40.”

“CHBRP estimates 39,178 enrollees (42%) using insulin have cost sharing that exceeds the SB 40 cap.”

Verify: SB 40 Would Cap Insulin Cost-Sharing at $35 and Ban Step Therapy RequirementsReport