Making Insulin Affordable for Children

Summary#

This bill requires private group and individual health plans to cover certain insulin products for people 26 years old or younger. For those covered insulin products, plans may not apply any deductible and may not charge more than the lesser of $35 or 25 percent of the negotiated price per 30-day supply (after price concessions). "Selected insulin products" means at least one product of each dosage form and each type of insulin when available, as chosen by the plan. Cost-sharing payments under the cap count toward any plan deductible or out-of-pocket maximum. The bill adds matching requirements across the Public Health Service Act, the Affordable Care Act rules for certain plans, ERISA-covered group plans, and the Internal Revenue Code. The rules take effect for plan years beginning on or after January 1, 2026. The Secretaries of HHS, Labor, and the Treasury may implement the provisions by guidance or other sub-regulatory action.

What it means for you#

  • If you are enrolled in a private group or individual health plan and are 26 or younger, your plan must cover selected insulin products without charging a deductible.
  • Your cost for each 30-day insulin supply cannot exceed the lesser of $35 or 25% of the negotiated price (after price concessions).
  • Any payments you make under this cap count toward your plan’s deductible and out-of-pocket maximum.
  • The rule applies to employer group plans (including ERISA plans), individual market plans, and certain catastrophic plans, starting with plan years beginning January 1, 2026.
  • If you are older than 26 or a plan does not select a particular insulin product as a "selected insulin product," the plan may apply other cost-sharing consistent with federal and state law.

Expenses#

No publicly available information on overall federal costs, savings, or budget estimates is included in the bill text or metadata.

Proponents' View#

No publicly available information on proponents' stated arguments or findings is included in the bill text or metadata.

Opponents' View#

No publicly available information on opponents' stated arguments or findings is included in the bill text or metadata.