Sponsors (10)
Official title: To amend title XXVII of the Public Health Service Act, the Internal Revenue Code of 1986, and the Employee Retirement Income Security Act of 1974 to establish requirements with respect to cost-sharing for certain insulin products, and for other purposes.
Introduced November 21, 2025 by Angela Craig · Last progress November 21, 2025
The bill makes insulin more affordable and immediately accessible in-network for many people with diabetes by capping and crediting cost-sharing, but it risks coverage gaps for specific insulin needs, higher costs for out-of-network users, potential premium or benefit shifts, and administrative or contracting responses that could blunt its impact.
People with diabetes who use in-network pharmacies will face much lower and more predictable out-of-pocket costs for covered insulin — cost-sharing capped at $35 per 30-day supply or 25% of the negotiated price beginning in 2026, and those payments will count toward plan deductibles and out-of-pocket maximums so patients reach additional coverage sooner.
Insured patients with diabetes will not have to meet a deductible for covered selected insulin products, improving immediate access to essential insulin when filled in-network.
People with diabetes who need specific brands or formulations could still face high costs or lack access because plans can limit the low-cost benefit to a plan-selected list of 'selected insulin products.'
Employers and insurers (and indirectly enrollees and taxpayers) could face higher plan costs from the cap that may be passed on through higher premiums or reduced benefits elsewhere.
People with diabetes who must use out-of-network pharmacies or providers could face higher cost-sharing and network restrictions, creating access barriers and higher costs for those patients.
Based on analysis of 2 sections of legislative text.
Requires group and individual market plans to cover selected insulin without a deductible and caps in‑network cost‑sharing at the lesser of $35 or 25% per 30‑day supply starting 2026.
Requires group and individual health plans to cover at least one dosage form of each insulin type selected by the plan without applying any deductible and caps in‑network cost‑sharing for a 30‑day insulin supply at the lesser of $35 or 25% of the negotiated price (net of price concessions) for plan years beginning on or after January 1, 2026. The bill defines which insulin products qualify, allows plans to exclude or charge higher cost‑sharing for out‑of‑network insulin, and ensures amounts paid under the cap count toward deductibles and out‑of‑pocket maximums.