Sponsors (9)
The bill lowers and speeds access to affordable insulin for many insured Americans, but does so using a plan‑selected formulary and a negotiated‑price metric that could limit coverage for some patients, create out‑of‑network cost barriers, raise plan costs for others, and add administrative complexity.
Insured people with diabetes — especially low‑income patients — will pay significantly less out‑of‑pocket for in‑network covered insulin because cost‑sharing is capped at $35 per 30‑day supply or 25% of the negotiated price beginning in 2026.
Insured patients using a plan's selected covered insulin products will not have to meet a deductible for those products, improving immediate access to needed insulin.
Cost‑sharing payments for covered insulin will count toward plan deductibles and out‑of‑pocket maximums, helping patients reach those limits sooner and obtain additional coverage sooner in a benefit year.
People who need specific insulin brands or formulations may be excluded from the low cost‑sharing terms if their product is not in a plan's 'selected insulin products' list, risking interrupted care or forced product switches.
Patients who rely on out‑of‑network pharmacies or providers could face higher cost‑sharing and network restrictions for insulin, creating access barriers and higher bills for those using non‑network sources.
Insurers and employers may face higher plan costs that could be passed on to enrollees, employees, or taxpayers through higher premiums, contributions, or reduced benefits.
Based on analysis of 2 sections of legislative text.
Requires group and individual health plans (from Jan 1, 2026) to cover selected insulin products with no deductible and in‑network cost‑sharing capped at the lesser of $35 or 25% per 30‑day supply.
Introduced November 21, 2025 by Angela Craig · Last progress November 21, 2025
Requires group and individual health plans to cover at least one form of each insulin type chosen by the plan with no deductible and with in‑network cost‑sharing per 30‑day supply capped at the lesser of $35 or 25% of the negotiated price (net of price concessions). The rule applies to plan years beginning on or after January 1, 2026, allows plans to set higher or exclude out‑of‑network cost‑sharing, and requires any payments under the cap to count toward the plan’s deductible and out‑of‑pocket maximums.