Sponsors (18)
Introduced March 25, 2026 by Jeanne Shaheen · Last progress March 25, 2026
The bill expands and accelerates access to lower‑cost insulin and increases plan and market transparency, especially for insured and some uninsured patients, but it risks shifting costs to employers/taxpayers, creating administrative burdens, limiting transparency and legal oversight, and leaving gaps for many uninsured people.
People with diabetes who have group or individual coverage will face much lower out‑of‑pocket costs for insulin (caps of $35/month starting 2027 and a 2028 cap of the lesser of $35 or 25% of negotiated price), improving affordability and access.
People with diabetes in employer‑sponsored group plans will receive the full value of insulin‑related rebates and faster remittance to plans, increasing the chance that savings reduce net insulin costs or lower premiums.
Limits on prior authorization and earlier coverage for catastrophic‑plan enrollees will reduce administrative delays and get insulin to high‑need patients sooner.
Employers, employees, and taxpayers could face higher premiums, employer contributions, or shifted costs because mandates, rebate passthroughs, and coverage requirements may reduce PBM/manufacturer revenue or raise plan expenses.
The caps (including the 25% of negotiated price from 2028) may still leave substantial out‑of‑pocket costs if negotiated prices remain high, so patients may not see the full intended relief.
Plans may limit in‑network access or impose higher cost‑sharing for out‑of‑network insulin dispensing, and plan selection of dosage forms could exclude brands some patients rely on, increasing costs or disrupting continuity of care for those without convenient in‑network access.
Based on analysis of 5 sections of legislative text.
Requires low-deductible, capped-cost insulin coverage in many plans, forces PBMs to pass insulin rebates to plans, tightens FDA petition rules, and funds a $100M state pilot for uninsured people.
Requires most group and individual health plans to cover selected insulin products with no deductible and capped cost-sharing (starting for plan years on/after Jan 1, 2027), forces pharmacy benefit managers and similar entities to pass 100% of insulin-related rebates and discounts through to group plans, tightens FDA citizen-petition rules that can delay generic or biosimilar approvals, and creates a five-year, $100 million grant pilot to help uninsured people buy insulin through 10 selected states. It also gives federal agencies authority to implement many insurance changes by guidance and sets reporting and audit requirements for rebates and the state pilot.