Sponsors (10)
The bill lowers and limits out‑of‑pocket insulin costs for young people and extends protections to dependent plans, providing immediate financial relief for many insulin users but risking higher premiums, administrative complexity, and potential gaps for patients who need non‑selected insulin products.
People age 26 and younger (including dependents): pay no deductible and at most $35 per 30‑day supply (or 25% of the negotiated price) for selected insulin, meaning substantially lower out‑of‑pocket costs for many young insulin users.
People with insulin-treated diabetes on affected plans (notably young adults): cost‑sharing payments for insulin will count toward plan deductibles and out‑of‑pocket maximums, helping them reach financial protection sooner.
Enrollees in qualified health plans and catastrophic-type dependent plans (including students and other dependents up to age 26): these plans must follow the insulin cost-sharing rule, expanding access to the capped cost protections across dependent and young-adult coverage types.
Patients who need less common insulin formulations or delivery devices: the rule applies only to 'selected' insulin products chosen by plans, so some necessary formulations or devices could remain subject to higher cost‑sharing or be excluded, risking worse health or higher costs for those individuals.
Plan enrollees and taxpayers (broadly): plans and issuers may absorb higher drug costs or restructure benefits to comply, which could push up premiums or other plan costs over time.
Group health plans and health insurance issuers: requiring that manufacturer/PBM price concessions be counted when calculating the 25% test could create complex accounting, disputes over net negotiated prices, and administrative burden.
Based on analysis of 2 sections of legislative text.
Requires plans to cover selected insulin for enrollees ≤26, eliminates deductibles, and caps cost‑sharing at the lesser of $35/30 days or 25% of negotiated price, effective 2026.
Official title: To provide for appropriate cost-sharing for individuals 26 years of age or younger for insulin products covered under private health plans.
Introduced April 3, 2025 by Greg Landsman · Last progress April 3, 2025
Requires group health plans and health insurance issuers to cover “selected insulin products” for enrollees age 26 or younger beginning January 1, 2026, eliminates deductibles for those covered insulin products, and caps cost‑sharing at the lesser of $35 per 30‑day supply or 25% of the negotiated price after price concessions. It also applies similar coverage rules to catastrophic‑type plans that cover dependents or young adults and clarifies that the change does not require coverage of other insulin products or people older than 26.