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CaliforniaSB 412025-2026 Regular SessionSenateWALLET

Pharmacy benefits.

Sponsored By: Aisha Wahab (Democratic), Scott Wiener (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

4 provisions identified: 4 benefits, 0 costs, 0 mixed.

Lower drug cost-sharing for patients

Beginning January 1, 2026, your plan or policy cannot charge drug cost-sharing that is higher than what it actually paid for the drug. If the plan or its drug manager discloses a net price, your cost share cannot be more than that net price. Pharmacies are free to tell you about cheaper options; PBM contracts cannot gag them. These rules apply when health plans or policies are issued, amended, or renewed on or after January 1, 2026.

Fair pay and choice for pharmacies

PBMs cannot discriminate against or steer patients away from nonaffiliated pharmacies, and cannot mislead people to use only PBM-owned pharmacies. Starting January 1, 2026, nonaffiliated pharmacies can deliver by mail, carrier, or their own staff, and PBMs generally cannot charge them for delivery. PBMs cannot charge electronic claim processing fees, cut payments later with DIR or similar reconciliations, or retroactively deny paid claims except for fraud, duplicate payments, or services not provided. PBMs must pay adjudicated claims even after contract termination (unless a fraud probe applies), cannot retaliate against pharmacies, and must give 30 days’ notice before material contract changes; they also cannot tell enrollees about a termination before notifying the pharmacy. From January 1, 2026, PBMs cannot use exclusivity deals unless they prove the lowest cost to payers and lowest cost sharing for members, and they cannot block nonaffiliated pharmacies from contracting with employers or payers.

Stronger oversight of drug managers

PBMs owe a fiduciary duty to payers and self‑insured employer plans and must disclose conflicts. On request, PBMs must give purchasers quarterly data on pricing, rebates, fees, and use (with confidentiality where required) and cannot penalize purchasers for asking. PBMs must file audited annual and quarterly financial reports; the state can survey and examine PBMs, and insurers must ensure their PBMs follow the law. Starting January 1, 2027 (or when licensing begins), insurers must use licensed PBMs; any contract terms that violate the article are void after January 1, 2029. The Attorney General can seek $1,000 to $7,500 per violation and other court orders and keeps full antitrust and consumer protection powers. Some PBM filings are confidential but can be shared with the Attorney General; certain integrated arrangements and Taft‑Hartley ERISA plans are exempt.

Drug managers must pass through prices and rebates

Starting January 1, 2026, spread pricing is banned in contracts with pharmacy benefit managers, and any spread-pricing terms become void on January 1, 2029. PBMs must use passthrough pricing, and 100% of manufacturer rebates must go to the payer to lower premiums, deductibles, coinsurance, and other cost sharing. PBM fees must be flat dollar amounts, disclosed in the contract, and cannot be tied to drug prices, rebates kept, or patient cost sharing. PBM bonuses can reward savings only when they lower premiums or give the lowest cost sharing for members.

Sponsors & Cosponsors

Sponsors

  • Aisha Wahab

    Democratic • Senate

  • Scott Wiener

    Democratic • Senate

Cosponsors

  • Mia Bonta

    Democratic • House

  • Heather Hadwick

    Republican • House

  • Gail Pellerin

    Democratic • House

  • Pilar Schiavo

    Democratic • House

  • Akilah Weber Pierson

    Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 219 • No: 2

Senate vote • 9/10/2025

Item 50 — Senate SFLOOR

Yes: 40 • No: 0

House vote • 9/9/2025

Item 115 — Assembly AFLOOR

Yes: 69 • No: 2

legislature vote • 8/29/2025

Vote in CX25

Yes: 11 • No: 0

legislature vote • 7/15/2025

Vote in CX13

Yes: 11 • No: 0

legislature vote • 7/8/2025

Vote in CX08

Yes: 14 • No: 0

Senate vote • 5/28/2025

Item 115 — Senate SFLOOR

Yes: 37 • No: 0

legislature vote • 5/23/2025

Vote in CS61

Yes: 6 • No: 0

legislature vote • 5/12/2025

Vote in CS61

Yes: 7 • No: 0

legislature vote • 4/29/2025

Vote in CS53

Yes: 13 • No: 0

legislature vote • 4/23/2025

Vote in CS60

Yes: 11 • No: 0

Actions Timeline

  1. Chaptered by Secretary of State. Chapter 605, Statutes of 2025.

    10/11/2025Senate

  2. Approved by the Governor.

    10/11/2025legislature

  3. Enrolled and presented to the Governor at 2 p.m.

    9/17/2025legislature

  4. Assembly amendments concurred in. (Ayes 40. Noes 0. Page 2819.) Ordered to engrossing and enrolling.

    9/10/2025Senate

  5. In Senate. Concurrence in Assembly amendments pending.

    9/9/2025Senate

  6. Read third time. Passed. (Ayes 69. Noes 2. Page 3081.) Ordered to the Senate.

    9/9/2025House

  7. Ordered to third reading.

    9/4/2025House

  8. Read third time and amended.

    9/4/2025House

  9. Read second time. Ordered to third reading.

    9/3/2025House

  10. Read second time and amended. Ordered to second reading.

    9/2/2025House

  11. From committee: Do pass as amended. (Ayes 11. Noes 0.) (August 29).

    8/29/2025House

  12. August 20 set for first hearing. Placed on APPR. suspense file.

    8/20/2025House

  13. Read second time and amended. Re-referred to Com. on APPR.

    7/17/2025House

  14. From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 11. Noes 0.) (July 15).

    7/16/2025House

  15. From committee with author's amendments. Read second time and amended. Re-referred to Com. on JUD.

    7/9/2025House

  16. From committee: Do pass and re-refer to Com. on JUD. (Ayes 14. Noes 0.) (July 8). Re-referred to Com. on JUD.

    7/9/2025House

  17. From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

    6/30/2025House

  18. Referred to Coms. on HEALTH and JUD.

    6/5/2025House

  19. In Assembly. Read first time. Held at Desk.

    5/28/2025House

  20. Read third time. Passed. (Ayes 37. Noes 0. Page 1276.) Ordered to the Assembly.

    5/28/2025Senate

  21. From committee: Do pass. (Ayes 6. Noes 0. Page 1189.) (May 23).

    5/23/2025Senate

  22. Read second time. Ordered to third reading.

    5/23/2025Senate

  23. Set for hearing May 23.

    5/16/2025Senate

  24. May 12 hearing: Placed on APPR. suspense file.

    5/12/2025Senate

  25. Set for hearing May 12.

    5/2/2025Senate

Bill Text

  • Chaptered

    10/11/2025

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  • Enrolled

    9/12/2025

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  • Amended Assembly

    9/4/2025

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  • Amended Assembly

    9/2/2025

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  • Amended Assembly

    7/17/2025

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  • Amended Assembly

    7/9/2025

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  • Amended Assembly

    6/30/2025

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  • Amended Senate

    5/1/2025

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  • Amended Senate

    3/17/2025

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  • Introduced

    12/3/2024

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