SB 40

  • California Senate Bill
  • 2025-2026 Regular Session
  • Introduced in Senate Dec 03, 2024
  • Senate
  • Assembly
  • Governor

Health care coverage: insulin.

Abstract

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 generally prohibit a health care service plan contract or disability insurance policy issued, amended, delivered, or renewed on or after January 1, 2026, from imposing a copayment of more than $35 for a 30-day supply of an insulin prescription drug or imposing a deductible, coinsurance, or any other cost sharing on an insulin prescription drug, except as specified. On and after January 1, 2026, the bill would prohibit a health care service plan or disability insurer from imposing step therapy protocols as a prerequisite to authorizing coverage of insulin. 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.

Bill Sponsors (4)

Votes


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Actions


Jan 06, 2025

Senate

Read first time.

Dec 04, 2024

Senate

From printer. May be acted upon on or after January 3.

Dec 03, 2024

Senate

Introduced. To Com. on RLS. for assignment. To print.

Bill Text

Bill Text Versions Format
SB40 HTML
12/03/24 - Introduced PDF

Related Documents

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Sources

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