Sponsors (20)
Official title: To reduce the price of insulin and provide for patient protections with respect to the cost of insulin.
Introduced September 2, 2026 by Diana DeGette · Last progress September 2, 2026
The bill aims to make insulin and some biologics more affordable and easier to access—especially for insured diabetics and uninsured users who get navigation help—but does so in ways that may leave coverage gaps for some patients, shift costs to premiums or taxpayers, and reduce regulatory transparency and review trade-offs.
People with diabetes in regulated plans will face much lower insulin out-of-pocket costs beginning in 2028 (no deductible and a maximum of $35 or 25% per 30-day supply), and some catastrophic-plan enrollees can access selected insulin before hitting annual out-of-pocket limits.
Uninsured and low-income insulin users will gain navigation and outreach supports — a 24/7 hotline/website, ZIP-code links to FQHCs/pharmacies, targeted public education and partnerships — and a GAO study will identify where uninsured insulin users live and their demographics to inform future outreach.
Faster FDA review pathways and an expedited designation process could speed availability of lower-cost biosimilars, potentially improving access and reducing biologic procurement costs for hospitals and patients.
People who need out-of-network providers or specific insulin brands/formulations may not benefit from the low cost-sharing because plans can exclude out-of-network insulin and insurers can pick which products count as 'selected insulin products', leaving some patients with higher costs or reduced access.
Mandating lower cost-sharing and creating new programs and reviews could raise premiums, increase costs for employers or shift expenses to taxpayers (including added GAO/study costs, program funding, or FDA workload), producing wider economic effects.
Allowing agencies to implement key changes via guidance and exempting certain actions from the Paperwork Reduction Act reduces formal notice-and-comment opportunities and public visibility, limiting stakeholder input and congressional oversight.
Based on analysis of 6 sections of legislative text.
Requires most group and individual health plans to cover selected insulin without deductibles and caps 30-day cost-sharing at $35 or 25% (lower) from Jan 1, 2028; creates an uninsured insulin resource center, GAO study, and expedited biosimilar pathway.
Requires group and individual health plans to cover selected insulin products without a deductible and caps cost-sharing for a 30-day supply at $35 or 25% of the negotiated price (whichever is lower) beginning for plan years on or after January 1, 2028. It also bans most utilization management for those selected insulins, treats the benefit as a required covered service for certain market rules, and makes related statutory conforming edits. Creates a federally supported insulin resource center and hotline for uninsured people, directs a GAO study of uninsured insulin users, and establishes an expedited FDA review pathway for biosimilar insulins when there is inadequate competition. Agencies are authorized to implement the coverage rules by guidance through the end of 2029.