Sponsors (9)
The bill makes many insulin users better off by capping and crediting in-network cost-sharing to improve affordability and access, but it risks coverage gaps for non-selected products or out-of-network users and may shift or raise costs elsewhere and add contractual/billing complexity.
People with diabetes (especially those with chronic conditions and low incomes) will pay less out-of-pocket for covered in-network insulin because cost-sharing is capped at $35 per 30-day supply or 25% of the negotiated price starting in 2026, and those cost-sharing payments will count toward plan deductibles and out-of-pocket maximums.
Insured patients who use covered selected insulin products will have improved immediate access because they won’t have to meet a deductible for those products.
People with diabetes who need a specific brand or formulation could still face higher costs or gaps in coverage because plans can limit the benefit to a plan-selected set of "selected insulin products," potentially excluding some medically necessary products.
People who use out-of-network pharmacies or providers (including some rural or specialty pharmacy users) may face higher cost-sharing and access barriers for insulin delivered out-of-network.
Insurers and employers could face higher plan costs from the cap, which may be passed on to enrollees through higher premiums or reduced benefits, affecting taxpayers and middle-class families who buy or sponsor coverage.
Based on analysis of 2 sections of legislative text.
Caps in‑network insulin cost‑sharing at $35 or 25% per 30‑day supply and bans deductibles for selected insulin products starting in 2026.
Introduced November 21, 2025 by Angela Craig · Last progress November 21, 2025
Requires health plans and insurers to cover certain insulin products without applying any deductible and to limit in‑network cost‑sharing for a 30‑day supply to the lesser of $35 or 25% of the negotiated price (after price concessions). The rule applies to group and individual health coverage for plan years beginning on or after January 1, 2026. Plans must designate at least one dosage form of each insulin type as a “selected insulin product.” The law allows plans to exclude out‑of‑network insulin from the cap or charge higher out‑of‑network cost‑sharing, counts payments under the cap toward deductibles and out‑of‑pocket limits, and does not force coverage or the cap for insulin products that are not designated as selected insulin products.