Health care coverage: insulin.

California Senators Wiener and Wahab propose new limits on insulin costs through amendments to state health care and insurance codes, establishing a $35 monthly cap on out-of-pocket expenses for insulin prescriptions. The legislation phases in cost controls, applying first to large group health plans in 2026 and extending to individual and small group plans in 2027.

The bill prohibits health insurers from requiring step therapy protocols for insulin coverage starting in 2026, while mandating that formularies include at least one insulin option for each drug type. For individual and small group plans with tiered formularies, the $35 cap applies to Tier 1 and Tier 2 insulin medications, with provisions for accessing higher-tier options at the capped rate when clinically necessary.

The measure maintains existing requirements for diabetes management supplies and services, including coverage for blood glucose monitors, testing strips, insulin pumps, and diabetes education programs. Health plans must continue providing these benefits without reducing current coverage levels, though high-deductible health plans may modify cost-sharing requirements to maintain compliance with federal regulations.