Scott Wiener
- Democratic
- Senator
- District 11
Author
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.
Chaptered by Secretary of State. Chapter 737, Statutes of 2025.
Approved by the Governor.
Enrolled and presented to the Governor at 3 p.m.
Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2709.) Ordered to engrossing and enrolling.
Read third time. Passed. (Ayes 79. Noes 0. Page 2865.) Ordered to the Senate.
In Senate. Concurrence in Assembly amendments pending.
Ordered to third reading.
Read third time and amended.
Read second time. Ordered to third reading.
From committee: Do pass. (Ayes 15. Noes 0.) (August 20).
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (July 15).
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
June 24 hearing postponed by committee.
In Assembly. Read first time. Held at Desk.
Read third time. Passed. (Ayes 37. Noes 0. Page 1280.) Ordered to the Assembly.
Read second time. Ordered to third reading.
Read second time and amended. Ordered to second reading.
From committee: Do pass as amended. (Ayes 6. Noes 0. Page 1189.) (May 23).
Set for hearing May 23.
April 21 hearing: Placed on APPR. suspense file.
Set for hearing April 21.
Read second time and amended. Re-referred to Com. on APPR.
From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0. Page 635.) (April 2).
Set for hearing April 2.
From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
Read first time.
From printer. May be acted upon on or after January 3.
Introduced. To Com. on RLS. for assignment. To print.
| Bill Text Versions | Format |
|---|---|
| SB40 | HTML |
| 12/03/24 - Introduced | |
| 03/17/25 - Amended Senate | |
| 04/07/25 - Amended Senate | |
| 05/23/25 - Amended Senate | |
| 06/27/25 - Amended Assembly | |
| 07/17/25 - Amended Assembly | |
| 08/29/25 - Amended Assembly | |
| 09/12/25 - Enrolled | |
| 10/13/25 - Chaptered |
| Document | Format |
|---|---|
| 04/01/25- Senate Health | |
| 04/18/25- Senate Appropriations | |
| 05/23/25- Senate Appropriations | |
| 05/27/25- Sen. Floor Analyses | |
| 07/11/25- Assembly Health | |
| 08/18/25- Assembly Appropriations | |
| 08/22/25- ASSEMBLY FLOOR ANALYSIS | |
| 09/02/25- ASSEMBLY FLOOR ANALYSIS | |
| 09/03/25- Sen. Floor Analyses |
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