Sponsors (14)
Introduced March 25, 2026 by Jeanne Shaheen · Last progress March 25, 2026
The bill makes meaningful, near‑term insulin affordability and access improvements for many insured people and pilots relief for some uninsured, while relying on administrative changes and market incentives that risk cost‑shifting, reduced choice, legal uncertainty, and uneven benefits for the uninsured.
Millions of people with diabetes who have private group or individual coverage will face much lower monthly out‑of‑pocket insulin costs (deductible elimination starting 2027, $35/month cap before 2028 and thereafter the lesser of $35 or 25% of negotiated price; insulin payments count toward deductibles and out‑of‑pocket maximums).
People with diabetes will have fewer access barriers to selected insulin products because plans cannot impose prior authorization or similar utilization management (except for clinical safety/quantity limits), and catastrophic-plan enrollees get coverage before meeting annual out‑of‑pocket thresholds.
Health plans will receive full rebate pass‑throughs and greater transparency (annual disclosure and audit rights), reducing PBM incentives to favor higher‑priced insulin products and enabling plans to make more cost‑effective formulary choices.
PBMs, manufacturers, or plans could shift costs — by raising list prices, fees, or premiums or limiting out‑of‑network benefits — so some patients (especially uninsured people, those using out‑of‑network pharmacies, and those in non‑group plans) could still face high insulin costs despite the caps and rebate rules.
Plans may limit patient choice by covering only at least one product per dosage form as chosen by the plan, potentially omitting some branded or newer insulin options and restricting access to preferred therapies.
Implementation and enforcement uncertainty plus possible legal challenges (federal guidance until 2030, PBM/insurer litigation risk) and the exemption from the Paperwork Reduction Act could create administrative complexity and transitional confusion for plans, providers, and patients.
Based on analysis of 5 sections of legislative text.
Requires coverage of selected insulin products with limited cost‑sharing, forces PBMs to return insulin rebates to plans, tightens FDA petition rules, and funds a $100M state insulin pilot.
Requires most employer and individual health plans to cover a set of designated insulin products with no deductible and capped cost‑sharing per 30‑day supply beginning with plan years on/after Jan 1, 2027, and lowers that cap in later years. Forces PBMs and pharmacy benefit vendors to remit 100% of insulin‑related rebates and other remuneration back to the group health plan with disclosure and audit rights. Changes FDA procedures so citizen petitions that may be delay-motivated can be identified and referred to the FTC and requires petition exhaustion before certain lawsuits. Creates a 5‑year, $100 million grant pilot for 10 states to expand affordable insulin access for uninsured residents through FQHCs and retail pharmacies.