Emma Kleck has been totally dependent on insulin, the lifesaving medication for people living with diabetes, for 25 years.
Kleck, 32, of Santa Cruz, was diagnosed with the rarer Type 1 diabetes at age 7. About 3.5 million Californians have a form of diabetes and need constant doses of insulin, a hormone that keeps blood sugar levels in check, to stay alive.
“I’m so reliant on this liquid,” Kleck said. “I guess I try not to think about it a lot. I wouldn’t be functional without it after three or four hours.”
Insulin is notoriously expensive in the U.S. — more than 10 times the cost in other countries, according to one study. Kleck, a nurse practitioner at a community health clinic in Santa Cruz, where half of her patients worry about affording their insulin, said some are forced to “ration” their insulin in a dangerous attempt to save money.
Two new state policies that are expected to pull the cost of insulin back down to Earth have thrilled Kleck and others with diabetes in California.
Gov. Gavin Newsom, a Democrat, kickstarted a plan in 2020 to contract the manufacturing of California’s own insulin and sell it for less. That strategy, though behind schedule, is finally bearing fruit: Generic insulin branded “CalRx” will reach the market in January, at the more-affordable price of $55 for about a month’s supply. In 2019, the average person with diabetes paid about $82 per month. It’s the first time a U.S. state will sell its own insulin.
In October, Newsom signed a separate law that limits health insurance co-pays and deductibles for insulin to $35 a month. The governor vetoed a version of that bill in 2023, angering some Democrats and diabetes advocates, but he reversed course this year. Depending on their health plan, Californians will see the benefits this January or in January 2027.
Two state lawmakers from the Bay Area pushed the bill across the finish line this year: Sen. Scott Wiener of San Francisco and Sen. Aisha Wahab of the East Bay and Silicon Valley, both Democrats.
The California-brand insulin and co-pay cap “complement each other so well to give Californians more affordable options than ever before,” said Christine Fallabel, a policy executive for the Virginia-based American Diabetes Association.
But the plans have some limits. So far, the state is only offering one type of insulin: glargine, a long-acting medication that isn’t the main insulin used by many with the most common form of diabetes, Type 2, and all people living with Type 1 diabetes. California’s drug partnership is working on getting a fast-acting insulin to market for those patients.
And the market for insulin has changed fast. Since 2023, drug companies have cut costs voluntarily, spurred by government interventions like California’s. Before that, in 2019, about 9% of people with diabetes were paying a whopping $315 per month, KFF Health News reported.
Prices for insulin are sky-high overall in the U.S., even though the medication is inexpensive for drug companies to produce. But the actual cost borne by those with diabetes can vary wildly depending on their access to health insurance, the fine print of different health plans and the kind of insulin they use.
Christine Christiansen, who lives in Danville, said her son Jack was diagnosed with Type 1 diabetes in 2017. He is now 19 and studying at Notre Dame University.
For now, Jack is covered by his parents’ Anthem health insurance, and a three-month supply of insulin costs the family $180, Christiansen said. But she said her son is anxious about his costs after he turns 26, when he’ll need to obtain his own insurance.
Roughly a quarter of the 8 million Americans who use insulin are forced to ration because they can’t afford it, according to a 2025 Yale School of Medicine study. The risks of that are serious: diabetic shock, blindness, lost limbs, heart attacks and death.
“You shouldn’t have to have health insurance charging you exorbitant amounts when you know it really doesn’t cost that,” Christiansen said.
Newsom’s health policy chiefs say California-branded insulin will be more affordable because it is produced without a profit motive, unlike that made by large, for-profit pharmaceutical companies.
Producing the insulin is Civica Rx, a Utah nonprofit that manufactures generic versions of drugs, to which the state awarded a $50 million contract. Civica will receive the profits of drug sales, which “are intended to cover the costs of insulin production going forward,” said Andrew DiLuccia, a spokesperson for the California Department of Health Care Access and Information.
Insulin has increasingly become a poster child of the runaway costs borne by American health patients, and advocates have pressured politicians to find solutions. In 2022, President Joe Biden limited co-pays for the medication to $35 a month for those enrolled in Medicare’s drug coverage. In November, President Donald Trump announced he’d reached a deal to cap some of Novo Nordisk’s insulin products at $35 a month through TrumpRx, a direct-to-consumer prescription drug market.
Drug companies followed suit. The new CalRx insulin is interchangeable with Lantus, the top-prescribed insulin in the country. Lantus is manufactured by Sanofi, a pharma giant based in France. The company announced in September that Lantus will cost $35 per month for all users under its expanded patient assistance program.
“We know that some people are still falling through the cracks and have trouble affording their insulin,” Evan Berland, a spokesperson for Sanofi, said in an email.
Other insulin manufacturers, Eli Lilly and Novo Nordisk, also debuted cost-saving programs. Jacob Sherkow, a professor of law and medicine at the University of Illinois who is watching California’s strategy, said companies are doing so in part because the state’s foray into the insulin market is putting “downward pressure” on prices.
But Newsom’s administration and some health providers are tepid on the discount programs. DiLuccia said those offerings “do not actually lower insulin prices” because the health system is still bearing the burden of high costs, which will drive premiums higher for patients.
Marilyn Tan, an endocrinologist and clinical professor of medicine at Stanford University School of Medicine, said those discounts benefit some patients. But Tan said others don’t have the time and resources to navigate what she described as a time-intensive process with lots of paperwork to get the reduced costs. The CalRx insulin, she said, has none of those hurdles.
Although Tan is excited about the state-branded insulin, she said costs for people with diabetes will still add up. Insulin is just one cost they may have to stomach, along with insulin pumps, blood glucose monitoring devices and other medications.
Behind the scenes, California and Civica are planning to debut a fast-acting insulin as well, Diluccia said.
“Civica is making good progress, and the State of California remains committed to making sure this initiative is successful,” he said in an email.
CalRx has already offered reduced-price naloxone, the life-saving medication that reverses opioid overdoses. And the state gained new legal authority in June to purchase brand-name drugs. That may include medication abortion pills, the governor’s office said.