Legislature Sends Senator Wiener’s Bill to Cap Insulin Co-Pays at $35 to the Governor
SACRAMENTO – The Legislature passed Senator Scott Wiener’s (D-San Francisco) Senate Bill 40 — capping insulin co-pays at $35 — with a vote of 40-0 in the Senate and 79-0 in the Assembly. Prescription drugs are a major driver of high costs: three in ten adults ration or skip medications they are prescribed to take due to cost. The cost of insulin is an especially acute problem, especially for seniors and working class families, and SB 40 aligns California with dozens of other states that have passed laws to contain these costs.
“If we believe healthcare is a right, we have to make it affordable for everyone. This bill ensures no family will be forced to choose between buying insulin and putting food on the table in California again,” said Senator Wiener. “Working people are building the future of California and we must make it affordable for them to live a healthy and thriving life here. I’m thrilled to send this bill to the desk of the Governor and know he will stand up for affordable healthcare for all Californians.”
About 4,037,000 adult Californians have diabetes, with an additional 263,000 cases of Type I diabetes diagnosed each year. This rate of new cases is particularly high and disproportionately affects the elderly, men, and low-income people. Insulin is essential for all people living with Type I diabetes and many living with Type II, meaning that millions of Californians rely on the drug.
Research has found that increased insulin costs are being driven by the small number of manufacturers and the rising role of middlemen such as pharmaceutical benefit managers. A 2021 study from the University of Southern California found that the share of insulin expenditures going to middlemen—PBMs, pharmacies, wholesalers, and health plans - had reached 53% by 2018, but from 30% in 2014.
The price of insulin has tripled over the past decade, with most of the increase going to middlemen and rising corporate profits. As a result of the increase, one in four people using insulin has reported insulin underuse because they can’t afford the full dose. Four in five Americans in need of insulin have incurred thousands of dollars in credit card debt to pay for the medication according to a recent survey.
Lawmakers and regulators at all levels of government have attempted to tackle the skyrocketing costs of insulin in recent years. Last August, Congress passed the Inflation Reduction Act, which capped the price of insulin at $35 a month for seniors covered by Medicare. The legislation did not cover private insurers as SB 40 would, and the future of the provision is uncertain with a newly elected Republican majority in Congress.
SB 40 would lower the crippling cost of insulin for patients by prohibiting private health insurers and health maintenance organizations (HMO) from imposing deductibles on prescription insulin drugs. It would also require that they and limit co-pays to a maximum payment of $35 for a 30 day supply.
SB 40 would also prohibit step-therapy requirements for insulin, unless health plans have at least one insulin for each drug type covered, similar to what is in statute for antiretroviral drugs for HIV treatment.
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