Health care coverage: insulin.
- Caps the cost of a 30-day insulin supply at $35 for health insurance plans starting January 2026.
- Prohibits insurers from requiring patients to try cheaper insulin options before covering preferred types.
- Requires coverage of diabetes education, training, and medical nutrition therapy by licensed professionals.
- Mandates coverage of essential diabetes supplies including glucose monitors, test strips, and insulin pumps.
Senators Wiener and Wahab's insulin affordability measure caps out-of-pocket costs at $35 for a 30-day supply of insulin prescriptions under California health plans and insurance policies starting January 2026, with provisions extending to individual and small group markets in 2027.
The legislation prohibits health plans from requiring step therapy protocols as prerequisites for insulin coverage, except when at least one insulin option in each drug category is available without such requirements. Drug categories include rapid-acting, short-acting, intermediate-acting, long-acting, ultra-long-acting, and premixed insulins. The bill maintains existing requirements for plans to cover diabetes management supplies and self-management training provided by licensed healthcare professionals.
For high-deductible health plans, the $35 cost-sharing cap applies unless it would conflict with federal requirements. The measure also extends these cost limitations to insulin products labeled or produced by the state once California develops this capability. According to the bill's findings, over 4 million California adults have diabetes, with one in four insulin users reporting rationing due to costs.
This bill was recently introduced. Email the authors to let them know what you think about it.
Introduced By
Latest Voting History
| Ayes | Noes | NVR | Total | Result |
|---|---|---|---|---|
| 11 | 0 | 0 | 11 | PASS |
 Anna CaballeroD Senator | Committee Member |  Not Contacted | |
 Scott WienerD Senator | Bill Author | Not Contacted | |
 Tim GraysonD Senator | Committee Member | Not Contacted | |
 Joaquin ArambulaD Assembly Member | Bill Author | Not Contacted | |
 Susan RubioD Senator | Bill Author | Not Contacted |
| Bill Number | Title | Introduced Date | Status | Link to Bill |
|---|---|---|---|---|
SB-90 | Health care coverage: insulin affordability. | January 2023 | Vetoed | |
Health care coverage: insulin cost sharing. | February 2021 | Failed | ||
Health care coverage: insulin affordability. | December 2020 | Failed | ||
Insulin cost-sharing cap. | February 2020 | Failed |
- Caps the cost of a 30-day insulin supply at $35 for health insurance plans starting January 2026.
- Prohibits insurers from requiring patients to try cheaper insulin options before covering preferred types.
- Requires coverage of diabetes education, training, and medical nutrition therapy by licensed professionals.
- Mandates coverage of essential diabetes supplies including glucose monitors, test strips, and insulin pumps.
This bill was recently introduced. Email the authors to let them know what you think about it.
Introduced By
Senators Wiener and Wahab's insulin affordability measure caps out-of-pocket costs at $35 for a 30-day supply of insulin prescriptions under California health plans and insurance policies starting January 2026, with provisions extending to individual and small group markets in 2027.
The legislation prohibits health plans from requiring step therapy protocols as prerequisites for insulin coverage, except when at least one insulin option in each drug category is available without such requirements. Drug categories include rapid-acting, short-acting, intermediate-acting, long-acting, ultra-long-acting, and premixed insulins. The bill maintains existing requirements for plans to cover diabetes management supplies and self-management training provided by licensed healthcare professionals.
For high-deductible health plans, the $35 cost-sharing cap applies unless it would conflict with federal requirements. The measure also extends these cost limitations to insulin products labeled or produced by the state once California develops this capability. According to the bill's findings, over 4 million California adults have diabetes, with one in four insulin users reporting rationing due to costs.
Latest Voting History
| Ayes | Noes | NVR | Total | Result |
|---|---|---|---|---|
| 11 | 0 | 0 | 11 | PASS |
Anna CaballeroD Senator | Committee Member | Not Contacted | |
Scott WienerD Senator | Bill Author | Not Contacted | |
Tim GraysonD Senator | Committee Member | Not Contacted | |
Joaquin ArambulaD Assembly Member | Bill Author | Not Contacted | |
Susan RubioD Senator | Bill Author | Not Contacted |
| Bill Number | Title | Introduced Date | Status | Link to Bill |
|---|---|---|---|---|
SB-90 | Health care coverage: insulin affordability. | January 2023 | Vetoed | |
Health care coverage: insulin cost sharing. | February 2021 | Failed | ||
Health care coverage: insulin affordability. | December 2020 | Failed | ||
Insulin cost-sharing cap. | February 2020 | Failed |