INSULIN Act of 2026
- Sponsor
- Rep. DeGette, Diana [D-CO-1]
- Committees
- Education and Workforce Committee (primary)
- Last action
- Sep 2, 2026
Bottom line
The INSULIN Act of 2026 seeks to make insulin more affordable for insured individuals by capping out-of-pocket costs and for uninsured individuals by providing resource assistance, while also promoting biosimilar competition.
What it actually does
This bill aims to lower insulin costs by capping out-of-pocket expenses for selected insulin products under most health plans at $35 or 25% of the negotiated price (whichever is less) per 30-day supply, starting January 1, 2028. It also establishes an Insulin Resource Center and hotline for uninsured individuals, and seeks to expedite the development and review of competitive biosimilar insulin products to increase market competition.
Proponents argue
Proponents argue that the bill directly addresses the critical issue of high insulin costs, ensuring that individuals with diabetes can access life-saving medication without facing prohibitive financial barriers. They emphasize that capping out-of-pocket costs provides immediate relief, while the resource center supports uninsured populations, and biosimilar competition will drive down prices long-term.
Opponents contend
Opponents might argue that price caps could lead to higher premiums for other plan members or shift costs elsewhere in the healthcare system, potentially discouraging innovation in new insulin therapies. Some may also contend that the biosimilar provisions do not go far enough or could be gamed by manufacturers, or that the resource center is an insufficient solution for the uninsured without broader coverage reforms.
The bill is relatively concise, allowing an informed reader to understand its core provisions and implications within a reasonable timeframe.
Section 2(a), amending Subpart II of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-11 et seq.) by adding Section 2729A.
Capping Out-of-Pocket Costs for Selected Insulin Products
For plan years starting January 1, 2028, group health plans and health insurance issuers must cover "selected insulin products" without applying a deductible. They cannot impose cost-sharing exceeding $35 per 30-day supply, or 25% of the negotiated price (net of all price concessions), whichever is less. This applies to at least one of each dosage form and delivery device of each different type of insulin, when such form is licensed and marketed.
Supporters argue
Supporters argue this provision directly addresses the affordability crisis for insulin, preventing patients from rationing or foregoing essential medication due to high costs. It ensures predictable and manageable expenses for a life-sustaining drug.
Critics contend
Critics might argue that while beneficial for patients, this mandate could lead to increased premiums for all insured individuals or shift costs to other areas of healthcare, potentially impacting overall plan affordability.
Tradeoffs
Balances immediate patient affordability with potential broader impacts on health insurance premiums and plan design.
Section 2(c), amending Section 1302(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(e)).
Insulin Coverage for Catastrophic Health Plans
For plan years beginning on or after January 1, 2028, catastrophic health plans must provide coverage for selected insulin products, in accordance with the new cost-sharing caps, even before an enrolled individual has met their annual deductible. This ensures immediate access to affordable insulin for those on high-deductible plans.
Section 5
Establishment of an Insulin Resource Center and Hotline for Uninsured Individuals
The Secretary of Health and Human Services is directed to award a grant to an eligible entity to establish and maintain a resource center and a 24/7 hotline. This center will provide information on manufacturer and other assistance programs for affordable insulin, facilitate enrollment, and offer public education, specifically targeting uninsured individuals.
Section 6, amending Section 351(k) of the Public Health Service Act (42 U.S.C. 262(k)).
Accelerated Review for Competitive Biosimilar Insulin Products
This section authorizes the Secretary to expedite the development and review of applications for biosimilar biological products designated as "competitive biosimilar biological products." A product qualifies if there is "inadequate biosimilar competition" (fewer than 3 licensed biosimilars for a reference product, and at least 3 years have passed since all exclusivity periods expired for the reference product or its biosimilars).
States that Chapter 35 of title 44, United States Code (the Paperwork Reduction Act of 1995) shall not apply to the provisions of, including the amendments made by, this title.
Section 3(b)
Why it matters:This is a common legislative practice to streamline implementation of new programs or regulations, avoiding delays associated with federal information collection requirements. It's generally a procedural efficiency measure rather than an attempt to hide something.
Case for: Supporters would argue that exempting these provisions from the Paperwork Reduction Act allows for faster implementation of critical insulin affordability measures, ensuring patients receive benefits without undue administrative delays.
Case against: Critics might contend that bypassing the Paperwork Reduction Act could lead to less oversight on data collection, potentially impacting transparency or the quality of information gathered for program evaluation, though for this specific bill, the impact is likely minimal.
Estimated impact: Facilitates quicker rollout of the new insulin cost-sharing rules and the resource center by reducing administrative burden on agencies.
Authorizes the Secretaries of Health and Human Services, Labor, and the Treasury to implement the bill's provisions for plan years beginning on or after January 1, 2028, and ending not later than January 1, 2030, through subregulatory guidance, program instruction, or otherwise.
Section 3(a)
Why it matters:This is a common legislative tool to give agencies flexibility in quickly issuing rules and interpretations without going through the lengthier formal rulemaking process, especially for time-sensitive or complex new policies. It's often for efficiency.
Case for: Proponents would argue that this allows for a more agile and responsive implementation of the insulin cost-sharing requirements, enabling agencies to quickly address unforeseen issues and provide necessary clarity to health plans and insurers.
Case against: Opponents might express concern that relying on subregulatory guidance reduces public input and transparency compared to formal rulemaking, potentially leading to less robust or less publicly vetted implementation details.
Estimated impact: Enables faster and more flexible rollout of the new insulin cost-sharing requirements, but with potentially less public scrutiny on the specific implementation details.