Health Net Phase-In of SB 40 Insulin Coverage

As of January 1, 2026, Health Net has applied the SB 40 – Insulin Coverage as per California law. This update outlines the phased SB 40 application by market segment. It also highlights key benefit impacts. 

Overview

SB 40 requires health plans to cap member cost sharing for insulin at $35 per prescription for up to a 30-day supply. (Subject to plan design and renewal timing.)

Phase 1: Large Group health plans

• Begins: January 1, 2026.
• Applies to: Large Group plans that renew on or after January 1, 2026.
  • $35 maximum copay for insulin per prescription for up to a 30-day supply.
  • Applies to formulary and approved non-formulary insulin.
  • Insulin is exempt from the deductible. This includes high-deductible health plans (HDHPs).
  • Members who pay less than $35 today will still be able to pay the lower amount.

Phase 2: Small Group & Individual Family Plans (IFP)

• Begins: January 1, 2027 at renewal.
• SB 40 will be applied at renewal starting January 1, 2027. More information will be shared closer to that date.

Important details

• The $35 cap applies per insulin prescription for a 30-day supply.
• Members who use many insulin types may have multiple copays. The $35 cap applies to each 30-day supply of insulin. The $35 cap also applies for non-formulary insulins approved by Health Net.
• Non-insulin diabetes medications (e.g., Ozempic, Trulicity, Mounjaro) are not included.
• Diabetic supplies and Continuous Glucose Monitors (CGMs) are not impacted. These items are covered under the Durable Medical Equipment (DME) benefit.
• Members who are now using non-formulary insulin, and have been approved through the Prior Authorization process, will qualify for the $35 cap.