Sponsors (7)
The bill sharply reduces out‑of‑pocket insulin costs and standardizes federal protections for many enrollees while leaving gaps for out‑of‑network or non‑selected products and risking cost shifts that could raise premiums and complicate marketplace plan design.
People with diabetes will pay no deductible and at most $35 (or 25% of the negotiated price) per 30‑day insulin supply, substantially lowering out‑of‑pocket costs for essential medicine.
People who buy insulin will have payments under the cap count toward their plan deductibles and out‑of‑pocket maximums, helping them reach limits sooner and reducing longer‑term cost burdens.
People enrolled in federal, employer, and exchange plans will see standardized insulin cost protections across PHSA, ERISA, and the Internal Revenue Code for 2026 plan years, reducing variation between plan types and improving predictability.
People who rely on out‑of‑network providers for insulin deliveries may still face high costs because plans can exclude out‑of‑network insulin or impose higher cost‑sharing for it.
People using insulin products not on a plan’s “selected insulin products” list may face normal cost‑sharing or lack coverage for some brands or formulations, limiting access to particular insulin types.
Insured people and employers may indirectly face higher premiums or contributions over time because capping cost‑sharing and counting it toward out‑of‑pocket limits can shift costs onto insurers and employers.
Based on analysis of 2 sections of legislative text.
Requires most private group health plans and individual market insurance to cover a set of insulin products without any deductible and to cap patient cost-sharing for a 30-day supply at the lesser of $35 or 25% of the negotiated price (after price concessions) starting with plan years on or after January 1, 2026. The rule applies across federal law that governs health plans and insurance markets and includes special rules for catastrophic plans, counting capped payments toward deductibles and out-of-pocket limits, and allowing higher out-of-network cost-sharing or exclusions for plans with networks.
Introduced November 21, 2025 by Angela Craig · Last progress November 21, 2025