California’s efforts to lower insulin costs need to address the middlemen

Oct. 22, 2025 8 AM PT

To the editor: I applaud California’s bold move to offer CalRx-branded insulin at lower prices (“Cheaper insulin will soon be available through California’s state prescription program,” Oct. 16). But for this effort to succeed, the state must address the middlemen and supply-chain pressures that often erase patient savings.

While pharmacies will buy a five-pack for $45 and sell at $55, pharmacy benefit managers can still impose hidden fees or restrictive contracts that shift costs back to the patient or squeeze small pharmacies. Many independent pharmacies in California have already closed after being reimbursed at less than cost, creating access deserts.

To safeguard CalRx, the state should require transparency in benefit management practices and fair pharmacy reimbursement. Senate Bill 41 is a good start. California’s insulin initiative is a great step forward, modeling an approach that may succeed nationwide if it protects both patients and pharmacies that serve them.

Padmashree Muralidharan, San Diego