Sponsors (29)
The bill expands access to and lowers out‑of‑pocket insulin costs for many patients while increasing transparency and speeding biosimilars, but it risks higher premiums and employer costs, administrative burdens, limited reach for some uninsured people, and reduced procedural oversight unless Congress offsets and regulators implement protections carefully.
Patients with diabetes (insured and some uninsured) will face much lower out‑of‑pocket insulin costs and better direct access: covered plans get $0 deductibles and a $35 monthly cap (starting 2027) with further caps/limits and catastrophic-plan coverage adjustments; grant-funded programs also cap uninsured participant costs at $35 and expand pharmacy access.
Greater PBM and plan transparency (full rebate disclosure, annual audit rights, faster remittance) gives plan sponsors visibility and control over insulin pricing, which can translate into lower net costs or premium relief for enrollees.
FDA measures to identify and limit delay-motivated petitions and to expedite biosimilar review can speed market entry of generics/biosimilars, increasing competition and potential price reductions over time.
Employers, plans, and consumers may face higher premiums or employer contributions as plans, PBMs, or manufacturers adjust pricing and plan design to offset lost rebate revenue and expanded mandates.
The fiscal-offset language is non‑binding: Congress is only 'encouraged' to offset costs, so taxpayers could still absorb added federal costs if offsets are not enacted.
New audit, disclosure, expedited‑review, and grant reporting requirements create administrative and compliance burdens and transitional costs for small employers, plan administrators, PBMs, states, and providers.
Based on analysis of 5 sections of legislative text.
Requires low/no‑deductible insulin coverage with per‑30‑day caps, forces PBMs to pass rebates to plans, tightens FDA petition rules, and funds a $100M state pilot for uninsured insulin.
Official title: Reduce the price of insulin and provide for patient protections with respect to the cost of insulin.
Introduced March 25, 2026 by Jeanne Shaheen · Last progress March 25, 2026
Requires group and individual health plans to cover selected insulin products with no deductible and tight per-30-day cost caps beginning in plan years on/after January 1, 2027, directs pharmacy benefit managers and related entities to pass 100% of insulin-related rebates and fees back to group plans, changes FDA citizen‑petition procedures that can delay generics or biosimilars, and creates a five‑year, $100 million grant pilot to help uninsured people obtain affordable insulin. The bill amends multiple federal laws (PHSA, ACA market rules, ERISA, and the Internal Revenue Code) to harmonize insulin coverage rules, adds strict transparency and remittance requirements for PBMs, adjusts FDA petition timelines to limit delay tactics, and funds state grants to expand low‑cost insulin access at community providers for uninsured residents.