California legislation that would limit the cost of a 30-day supply of insulin to $35 has passed the state Senate.

Senate Bill 90, sponsored by the American Diabetes Association and presented by Sen. Scott Wiener (D-San Francisco), was approved unanimously by the Senate May 22. The bill is now under consideration in the state’s Assembly.

“More than 37 million Americans have diabetes, a disease for which there is no cure. Many of these individuals, an estimated 8.4 million, require insulin to live,” said Lisa Murdock, Chief Advocacy Officer for the American Diabetes Association, in a January statement. “Unfortunately, the sky-rocketing prices for insulin have made this life-saving medication out of reach for many.”

Beyond capping co-payments, the legislation also prohibits insurance companies from imposing a deductible, coinsurance, or any other cost-sharing on an insulin prescription drug. This means patients won’t have to meet a yearly deductible before benefiting from the capped monthly price.

Insulin prescription drugs are used to control blood glucose levels to treat diabetes, according to a Senate analysis of the bill. The medication is often prescribed to help cells use sugar for energy, according to Cedars-Sinai Medical Center.

National surveys have shown that one-fourth of Americans who use insulin must ration the medication so they can pay for other essentials, like rent, food, and utilities, according to the diabetes association.

The cost of insulin tripled between 2002 and 2013, the association reports on its website.

Although 20 states and the District of Columbia have capped copayments on insulin, devices, or diabetes supplies, California has not yet made a similar move.

In a 2021 study by the RAND Corporation, a nonprofit public policy think tank, researchers found drug companies charge more for insulin in the U.S. than in nearly three dozen other countries. The average list price for a vial of insulin in Canada was $12 compared to $98.70 in the U.S.

“Those differences help explain why insulin has become a symbol of the high cost of American health care,” the RAND Corp. said in a press release. “Its prices have shot up in recent years, for reasons that are opaque at best, with those who can least afford it often paying the most.”

As part of the 2022 Inflation Reduction Act, the U.S. Congress capped co-pays for insulin at $35 for Medicare patients but private health plans were not included.

The cap went into effect Jan. 1 for Medicare Part D enrollees and is set to take effect July 1 for those enrolled in Medicare Part B.

“No one should be forced to choose between food and insulin,” Wiener said in a January statement. “If nonprofits like Civica Rx can sell insulin for $30, health plans and pharmacies have no business charging $400 for the same dose.”

According to Wiener, more than 4 million adult Californians have diabetes, with about 231,500 more cases diagnosed each year.

In March, Gov. Gavin Newsom announced that Civica Rx, a nonprofit generic drug and pharmaceutical company, would manufacture affordable insulin for $30.

Originally announced in 2019, the governor signed an executive order (pdf) and later the California Affordable Drug Manufacturing Act of 2020 that empowered the state to develop, produce, and distribute generic drugs to sell at a low cost.

California has a $50 million contract with Civica Rx to produce the three most commonly used long-acting and rapid-acting types of insulin in vial and pen forms.

Federal approval by the Food and Drug Administration is expected next year and the products should be available publicly shortly after that, according to a Senate analysis.

The Association of California Life and Health Insurance Companies and the California Association of Health Plans oppose SB 90. Both groups expressed concern over mandating specific limits on prices, considering the recent spike in insulin costs by pharmaceutical companies.

“This bill mandating a specific limit on the cost-sharing of a very specific piece of the overall health benefit plan will not achieve the goal of affordable or sustainable healthcare for all,” the groups wrote, according to a Senate analysis.