CA SB40

Caps out-of-pocket costs for insulin at $35 for a 30-day supply, applying to large group health plans starting January 1, 2026, and individual/small group plans starting January 1, 2027

Prohibits health care service plans and insurers from requiring step therapy (trying other medications first) before authorizing insulin coverage, effective January 1, 2026

Requires at least one insulin for each drug type (rapid acting, long acting, etc.) in all forms and concentrations to be included on prescription drug formularies

For individual and small group plans with tiered formularies, the $35 cap applies only to Tier 1 and Tier 2 insulin, but plans must provide the capped rate for higher-tier insulin if no lower-tier option is clinically appropriate

High deductible health plans must comply with the $35 cap unless doing so would conflict with federal requirements for such plans