Gov. Gavin Newsom signed Senate Bill 40 in Oct. 2025, aimed at regulating costs of insulin for patients on state-regulated healthcare plans such as Covered California and Medi-Cal. The bill went into effect on Jan. 1. Specifically, SB 40 caps patient co-pay costs of insulin at $35 for a 30-day supply. In addition, it establishes CalRx, a state initiative in partnership with Civica Rx and Biocon Biologics, which supplies $11 CalRx Insulin Glargine insulin pens — a form of insulin treatment that approximately 59% of Americans with diabetes rely on — to Californians through most pharmacies statewide. SB 40 also prohibits step therapy, a healthcare management policy that requires patients to try cheaper, more generic medications before insurers cover more expensive, doctor-recommended medications.
SB 40 serves as an amendment to California’s previous governing act, the Knox-Keene Health Care Service Plan Act — a 1975 plan that regulated health plans to guarantee coverage for medically necessary insulin. However, despite the act, insulin prices remained high, with diabetes medication often exceeding $200 a month in 2023. As a result, in 2023, Senator Scott Wiener proposed SB 90. Similar to SB 40, SB 90 aimed at capping insulin costs at $35 for a 30-day supply. However, Gov. Newsom vetoed the bill, stating that “California is working on a separate effort to manufacture and distribute insulin at a cheaper price,” referring to the CalRx pens. Later, SB 40, still including the price cap as well as an additional clause prohibiting step therapy, was proposed in late 2024, going through three amendments during 2025 before being signed into law.
Diabetes educator at a local hospital Barry Conrad explains that SB 40 will be especially beneficial to those who are uninsured or underinsured. He recalls that previously, a single vial of insulin could cost over $300, with a typical patient with diabetes relying on two to three vials per month. Conrad emphasizes that the $30 cap the bill offers will reduce financial strain for patients. However, Conrad also recognizes that with the cap, insurance companies will likely be required to cover a larger medical bill, which might increase costs for those with insurance. Still, he believes that ensuring patients with diabetes have reliable access to insulin should be a priority. In addition, he predicts a possible reduction of ER and hospital visits in general from patients who are lacking insulin.
“Without insulin, and without emergency room support, people with Type 1 diabetes will not live for more than a few days to weeks,” Conrad said in an email. “If a person with diabetes rations their insulin to have it last longer, they put themselves at risk of causing health problems related to diabetes, which includes blindness, heart problems, kidney problems and problems feeling their feet.”
AP Chemistry teacher Supriya Moore, who lives with Type 1 diabetes, experiences insulin rationing and fear of running out, something the Type 1 diabetes community terms “insulin insecurity.” Though insurance covers her medication, she says her life revolves around managing her insulin needs.
“During the holidays, we have parties and eat, and even though insurance covers the insulin, I’m always insecure, because I will be counting the amount of insulin I have in the fridge,” Moore said. “For individuals who are not covered through insurance, I’ve heard that they have to make a decision between insulin and other necessities. When they don’t have insurance to begin with, they have to ration a lot more than someone who’s covered through insulin. There’s always, at the back of our minds, the thought of ‘What if I run out of insulin?’ There’s that insecurity, and it compounds for individuals that don’t have insurance to cover it.”
Conrad also believes the cheaper pens will be helpful for patients, explaining that patients with Type 1 diabetes need one injection of long-acting insulin a day and an injection of short-acting insulin at each meal. Los Altos High School junior Erin Jesensky agrees with Conrad, emphasizing the necessity of affordable access to insulin pens. As someone who has lived with Type 1 diabetes since she was eight, Jesensky remembers using insulin pens before transitioning to her insulin pump. She explains that many people with diabetes rely on insulin pens.
“I know a lot of people who prefer the insulin pens to syringes or injections,” Jesensky said. “So it is definitely helpful to have that option, because if you can’t afford that insulin pump, the insulin pen is something that just makes it a lot easier to distribute insulin to yourself. It’s also smaller, it’s quicker and it’s preloaded, so you don’t have to go through all of the hassle of carrying all these different things and making sure nothing is too hot or too cold insulin wise.”
Jesensky also lauds the bill’s abolishment of step therapy. While she knows people who use and like older, less expensive diabetes management tools, she says that usually, the more expensive medications are more technologically advanced and better for managing the condition. She says that this bill is valuable for providing high-quality, state-provided, affordable insulin to all. As Jesensky gets older and starts managing her own medication and health, she says she’ll appreciate this medical safety net more.
“Right now, I’m super fortunate to have my parents pay for it and be able to afford it,” Jesensky said. “As of right now, I wouldn’t let it stop me from moving out of state. But I think as I get older, that’s definitely going to be something that I consider. My family’s also from the UK, and I’ve considered going back over there, where healthcare is free, because I would be able to have this stuff. But it also comes down to accessibility, because free doesn’t always mean that they’re accessible.”