This bill, the Affordable Insulin Now Act, requires many group and individual health plans to cover selected insulin products for plan years beginning on or after January 1, 2026. For those covered insulin products, plans and issuers may not apply any deductible and may not charge more than the lesser of $35 or 25 percent of the negotiated price (after price concessions) per 30-day supply. "Selected insulin products" means at least one product for each dosage form and each insulin type, when available, as chosen by the plan. The bill adds matching requirements in the Public Health Service Act, the Internal Revenue Code, and ERISA. Plans that use provider networks may impose higher cost-sharing or different coverage for insulin delivered by out-of-network providers. Any cost-sharing charged under the limits must count toward a plan's deductible and out-of-pocket maximums. The bill also requires certain catastrophic plans to provide the same selected insulin coverage before an enrollee reaches annual cost-sharing limits.
If you have a group or individual health plan covered by this bill and your plan includes the plan-selected insulin products, you should not have to meet a deductible for those products, and your copay or coinsurance per 30-day supply cannot exceed the lesser of $35 or 25% of the negotiated price after price concessions. Plans choose which insulin products are "selected." Out-of-network insulin may be treated differently by plans. Payments you make under these limits count toward your plan's deductible and out-of-pocket maximum.
The bill sets a per-30-day cost-sharing limit of the lesser of $35 or 25% of the negotiated price for selected insulin products. No publicly available information on the bill's overall federal or plan-level budgetary effects, administrative costs, or impacts on premiums and total spending is included in the bill text.
No publicly available information.
No publicly available information.