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SB 90 · 2023-24

Caps insulin costs at $35 per 30-day supply

Official subject Health care coverage: insulin affordability.

Vetoed Vetoed Oct. 7, 2023

Plain-language summary

Health plans and disability insurance policies cannot charge a copayment, coinsurance, deductible, or other out-of-pocket cost above $35 for a 30-day supply of insulin. High deductible health plans cannot apply any deductible or cost sharing to insulin. Applies to plans issued or renewed starting in 2024, and individual and small group plans starting in 2025.

How these summaries are written

Official summary · Legislative Counsel's Digest

Describes the final version (Enrolled, Sept. 14, 2023).

Read the official summary (4 paragraphs)

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 health care service plan contract or a disability insurance policy, as specified, issued, amended, delivered, or renewed on or after January 1, 2024, or a contract or policy offered in the individual or small group market on or after January 1, 2025, from imposing a copayment, coinsurance, deductible, or other out-of-pocket expense of more than $35 for a 30-day supply of an insulin prescription drug, and would prohibit a high deductible health plan from imposing a deductible, coinsurance, or other cost sharing on an insulin prescription drug, as specified. 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.

Official title

An act to amend Section 1367.51 of the Health and Safety Code, and to amend Section 10176.61 of the Insurance Code, relating to health care coverage.

Veto message · Oct. 7, 2023

The Governor's message, verbatim.

To the Members of the California State Senate:

I am returning Senate Bill 90 without my signature.

This bill would prohibit health plans from imposing a copayment of more than $35 for a 30-day supply of an insulin prescription drug.

Bringing down the costs of prescription drugs, and particularly insulin, has long been a priority of mine. People should not be forced to go into debt to get lifesaving medicines. In March, I announced the state's partnership with Civica to create our own line of CalRx biosimilar insulins that will cost no more than $30 per 10mL vial or $55 for five 3mL cartridges. This is a fraction of the current price for most insulins, and CalRx biosimilar insulins will be available to insured and uninsured patients nationwide. With CalRx, we are getting at the underlying cost, which is the true sustainable solution to high-cost pharmaceuticals. With copay caps however, the long-term costs are still passed down to consumers through higher premiums from health plans. As a state, we have led the nation in our efforts and investments to address the true underlying costs of insulin prescription affordability.

For these reasons, I cannot sign this bill.

Sincerely,

Gavin Newsom

Timeline

  1. Jan. 17, 2023 Introduced
  2. May 22, 2023 Passed Senate 40 yes, 0 no
  3. Sept. 11, 2023 Passed Assembly 79 yes, 0 no
  4. Sept. 18, 2023 Enrolled and sent to the Governor
  5. Oct. 7, 2023 Vetoed by the Governor
Full official history (32 actions)
  1. Jan. 17, 2023 Introduced: Introduced. Read first time. To Com. on RLS. for assignment. To print.
  2. Jan. 18, 2023 From printer. May be acted upon on or after February 17.
  3. Jan. 25, 2023 Referred to Com. on HEALTH.
  4. March 21, 2023 From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.
  5. April 3, 2023 Set for hearing April 12.
  6. April 10, 2023 April 12 set for first hearing canceled at the request of author.
  7. April 12, 2023 Set for hearing April 19.
  8. April 17, 2023 April 19 set for second hearing canceled at the request of author.
  9. April 18, 2023 Set for hearing April 26.
  10. April 27, 2023 From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 10. Noes 0. Page 940.) (April 26).
  11. May 1, 2023 Read second time and amended. Re-referred to Com. on APPR.
  12. May 2, 2023 Set for hearing May 8.
  13. May 8, 2023 May 8 hearing: Placed on APPR suspense file.
  14. May 12, 2023 Set for hearing May 18.
  15. May 18, 2023 From committee: Do pass. (Ayes 7. Noes 0. Page 1160.) (May 18).
  16. May 18, 2023 Read second time. Ordered to third reading.
  17. May 22, 2023 Passed Senate: Read third time. Passed. (Ayes 40. Noes 0. Page 1216.) Ordered to the Assembly.
  18. May 23, 2023 In Assembly. Read first time. Held at Desk.
  19. May 26, 2023 Referred to Com. on HEALTH.
  20. June 21, 2023 From committee: Do pass and re-refer to Com. on APPR. (Ayes 14. Noes 0.) (June 20). Re-referred to Com. on APPR.
  21. Aug. 16, 2023 From committee: Do pass. (Ayes 16. Noes 0.) (August 16).
  22. Aug. 17, 2023 Read second time. Ordered to third reading.
  23. Sept. 6, 2023 Read third time and amended.
  24. Sept. 6, 2023 Ordered to third reading.
  25. Sept. 11, 2023 Passed Assembly: Read third time. Passed. (Ayes 79. Noes 0. Page 3139.) Ordered to the Senate.
  26. Sept. 11, 2023 In Senate. Concurrence in Assembly amendments pending.
  27. Sept. 12, 2023 Assembly amendments concurred in. (Ayes 39. Noes 0. Page 2670.) Ordered to engrossing and enrolling.
  28. Sept. 18, 2023 Enrolled and sent to the Governor: Enrolled and presented to the Governor at 3 p.m.
  29. Oct. 7, 2023 Vetoed by the Governor: Vetoed by the Governor.
  30. Oct. 7, 2023 In Senate. Consideration of Governor's veto pending.
  31. Jan. 25, 2024 Stricken from file.
  32. Jan. 25, 2024 Veto sustained.