INSULIN Act of 2026

Summary#

This bill, called the INSULIN Act of 2026, requires most group and individual health plans to cover certain insulin products with low or no out-of-pocket costs. For a 30-day supply, plans may not apply any deductible and may not charge more than $35 per 30-day supply, or for plan years on or after January 1, 2028, the lesser of $35 or 25% of the plan's negotiated price after price concessions. Plans must cover at least one product for each insulin type and delivery form chosen by the plan. Plans may not impose prior authorization or similar rules on these insulin products except for safety, reasonable quantity limits, or other clinically justified reasons. The bill also requires catastrophic plans to cover these insulin products before an enrollee reaches the annual out-of-pocket limit. Federal agencies may implement the rules by guidance for plan years starting January 1, 2028 through January 1, 2030. The bill authorizes a GAO study of uninsured people who use insulin and creates a grant-funded resource center and 24/7 hotline to help uninsured people find assistance programs. The bill also gives the HHS Secretary authority to expedite review of certain biosimilar applications when there are fewer than three approved biosimilars for a reference product and at least three years have passed since related exclusivities ended.

What it means for you#

• If you have private or employer health coverage, your plan must cover selected insulin products and cannot make you meet a deductible for them. Cost-sharing per 30-day supply is capped as described above. Plans cannot generally require prior authorization for these covered insulin products.
• If you are on a catastrophic plan, the plan must provide the covered insulin products before you hit the annual cost-sharing limit.
• If you are uninsured, the bill funds a public resource center with a website and a 24/7 hotline to help find manufacturer and other assistance programs, pharmacies, and community health centers and to help people enroll in programs.
• The bill directs a study to better describe uninsured people who use insulin, including the places they live and their income and demographic information.

Expenses#

• The bill caps patient cost-sharing per 30-day supply: $35 for plan years before January 1, 2028; for plan years on or after January 1, 2028, the cap is the lesser of $35 or 25% of the negotiated price net of price concessions.
• The bill authorizes $2,000,000 in appropriations for each of fiscal years 2027 through 2032 to run the uninsured insulin resource center and hotline.
• The text allows HHS, Labor, and Treasury to implement provisions by subregulatory guidance for plan years beginning on or after January 1, 2028 and ending not later than January 1, 2030.
• No publicly available information on total federal budget effects or other costs beyond the specific authorized funding is provided in the bill text.

Proponents' View#

The bill states its purpose is "to reduce the price of insulin and provide for patient protections with respect to the cost of insulin." Provisions require lower out-of-pocket costs, limit prior authorization, create support for uninsured people, and seek faster biosimilar competition.

Opponents' View#

No publicly available information on opponents' views or objections is included in the bill text or provided metadata.