Sponsors (28)
The bill substantially expands insulin affordability and access (caps, rebate transparency, uninsured pilots, and steps to speed biosimilars) for many people with diabetes, but it risks higher premiums, market and PBM/manufacturer responses, added federal and compliance costs, limited geographic reach for uninsured assistance, and reduced procedural transparency and judicial oversight.
People with diabetes who have group or individual coverage (including catastrophic-plan enrollees) will face no deductible and have insulin cost-sharing capped (no more than $35 per 30‑day supply starting 2027, with additional caps/limits from 2028), reducing their out‑of‑pocket spending and improving access to needed insulin.
People with diabetes in employer‑sponsored/group plans and plan sponsors gain greater rebate pass‑through, audit rights, and faster remittance of insulin rebates, increasing transparency and returning more value to enrollees or lowering plan premiums.
Uninsured individuals in grant‑funded programs (targeted to 10 high‑need States) can get insulin at up to $35/month through the pilot, plus easier access via FQHC on‑site pharmacies and a national resource center/hotline to find assistance.
Employers, employees, and individuals may face higher premiums or increased employer contributions because plan costs and mandates (including extending requirements through ERISA/tax code and rebate pass‑through) could be shifted into premiums.
PBMs or manufacturers could respond by raising list prices, restructuring discounts, or otherwise changing pricing behavior, which could erode the intended out‑of‑pocket savings and leave uninsured or non‑group patients little better off.
The bill authorizes new federal spending (including up to $100M for grants and ongoing resource center costs) and creates additional regulatory/enforcement activities, increasing federal outlays and costs to taxpayers.
Based on analysis of 5 sections of legislative text.
Requires plans to cover selected insulin with no deductible and capped monthly cost sharing, mandates 100% insulin rebate pass‑through to plans, tightens FDA petition rules, and funds a $100M uninsured insulin grant pilot.
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 most group and individual health plans to cover selected insulin products with no deductible and a capped per-30‑day cost share (initially $35, later the lesser of $35 or 25% of negotiated price), requires PBMs and related entities to remit 100% of insulin-related rebates and discounts to group plans, tightens FDA citizen‑petition procedures that can delay generic/biosimilar approvals, and creates a five‑year, $100 million HHS grant pilot to help 10 States provide affordable insulin to uninsured people. Many implementation details (including temporary guidance authority) and reporting/audit rules for rebate remittances are included; most major plan changes take effect for plan years starting Jan 1, 2027, with some actuarial-rule changes applying Jan 1, 2028.