Affordable Insulin Now Act
- Sponsor
- Rep. Craig, Angie [D-MN-2]
- Committees
- Education and Workforce Committee (primary)
- Last action
- Nov 21, 2025
Bottom line
The bill aims to significantly reduce out-of-pocket costs for insulin for individuals covered by most health plans by eliminating deductibles and capping monthly cost-sharing at $35 or 25% of the negotiated price.
What it actually does
This bill amends the Public Health Service Act, the Internal Revenue Code, and the Employee Retirement Income Security Act to establish new requirements for health plans and insurance issuers regarding insulin cost-sharing. Specifically, for plan years beginning on or after January 1, 2026, it prohibits the application of deductibles to 'selected insulin products' and caps patient cost-sharing for these products at the lesser of $35 or 25% of the negotiated price per 30-day supply. It also clarifies how these rules apply to catastrophic health plans and actuarial value calculations under the Affordable Care Act.
Proponents argue
Supporters argue that this bill will make life-saving insulin more affordable and accessible for millions of Americans living with diabetes, preventing individuals from rationing their medication due to high costs. They emphasize that the current system often places an undue financial burden on patients, and this measure provides direct financial relief and ensures consistent access to essential treatment.
Opponents contend
Opponents might argue that while the intent to lower patient costs is laudable, capping insulin costs without addressing underlying drug pricing mechanisms could shift costs to premiums for all enrollees or to other healthcare services. They may also raise concerns about potential impacts on drug innovation or market dynamics, or the administrative burden on health plans.
The bill is concise and its core provisions are easily understandable, making it accessible for a quick review by an informed reader.
Section 2(a), adding new Section 2799A-11 to PHSA
Insulin Cost-Sharing Requirements for Health Plans and Issuers (PHSA)
This provision mandates that for plan years beginning on or after January 1, 2026, group health plans and health insurance issuers offering group or individual coverage cannot apply any deductible to 'selected insulin products.' Furthermore, it caps patient cost-sharing for these products at the lesser of $35 or 25% of the negotiated price (net of all price concessions) per 30-day supply. 'Selected insulin products' are defined as at least one of each dosage form and type of insulin, chosen by the plan or issuer.
Supporters argue
Supporters argue this directly addresses the financial burden on diabetic patients, ensuring they can afford essential medication without facing prohibitive deductibles or high co-pays, thereby improving health outcomes and reducing emergency care needs.
Critics contend
Some might argue that while beneficial for patients, these mandates could lead to higher premiums for all enrollees as plans absorb more costs, or potentially influence which insulin products are 'selected' by plans, limiting patient choice.
Tradeoffs
The provision balances the critical need for patient affordability and access to life-saving insulin against the potential for increased costs to be shifted to other parts of the healthcare system, such as higher premiums for all beneficiaries.
Section 2(b), adding new Section 9826 to IRC
Insulin Cost-Sharing Requirements for Group Health Plans (Internal Revenue Code)
This provision mirrors the PHSA amendment, applying the same deductible prohibition and cost-sharing caps ($35 or 25% of the negotiated price) for 'selected insulin products' to group health plans under the Internal Revenue Code. This ensures that employer-sponsored health plans subject to the tax code also comply with the new affordability standards, effective January 1, 2026.
Section 2(c), adding new Section 726 to ERISA
Insulin Cost-Sharing Requirements for Group Health Plans (ERISA)
This provision extends the same deductible prohibition and cost-sharing caps ($35 or 25% of the negotiated price) for 'selected insulin products' to group health plans and health insurance issuers offering group health insurance coverage under the Employee Retirement Income Security Act (ERISA). This ensures that the vast majority of private sector employer-sponsored health plans are covered by the insulin cost-sharing limits, effective January 1, 2026.
Section 2(d), amending Section 1302(d)(2) of the Patient Protection and Affordable Care Act (ACA)
Special Rule for Insulin Coverage and Actuarial Value
This amendment clarifies that the exemption of 'selected insulin products' from the application of any deductible, as mandated by this Act, shall not be considered when determining the actuarial value of a qualified health plan under the Affordable Care Act. This technical adjustment prevents plans from being penalized in actuarial value calculations for offering this specific, federally mandated benefit.
Section 2(e), amending Section 1302(e) of the ACA
Coverage of Insulin Products Under Catastrophic Plans
This amendment requires catastrophic health plans (a type of ACA plan typically featuring high deductibles and lower premiums) to provide coverage for 'selected insulin products' in accordance with the new PHSA requirements. Crucially, this coverage must be provided for a plan year even before an enrolled individual has incurred cost-sharing expenses up to their annual deductible. This ensures that insulin cost caps apply to catastrophic plans from day one, offering immediate relief to users.
Rule of Construction: Clarifies that the bill does not require coverage of, or prevent higher cost-sharing for, insulin products that are not 'selected insulin products.'
Section 2(a), (b), (c) - new sections 2799A-11(d), 9826(d), 726(d)
Why it matters:This is standard legislative practice to define the limits of a new mandate and avoid unintended interpretations, rather than an attempt to obscure.
Case for: Proponents would argue this provides necessary flexibility for health plans to manage their formularies and negotiate prices, ensuring they are not forced to cover every single insulin product at the capped rate, which could lead to unsustainable cost increases.
Case against: Critics might argue that this flexibility could still leave patients reliant on specific brands or types of insulin facing higher costs if their preferred product is not among those 'selected' by their plan, potentially creating a two-tiered system for insulin access.
Estimated impact: Limits the scope of the cost-sharing mandate to only those insulin products specifically chosen by plans, potentially impacting patient choice and costs for non-selected products.
Application of Cost-Sharing Towards Deductibles and Out-of-Pocket Maximums: Mandates that any cost-sharing payments made for selected insulin products under the new caps must count towards any deductible or out-of-pocket maximum that applies under the plan or coverage.
Section 2(a), (b), (c) - new sections 2799A-11(e), 9826(e), 726(e)
Why it matters:This is standard consumer protection language, ensuring that capped payments still contribute to overall financial limits, and is typically placed after the primary mandate.
Case for: Proponents would highlight this as a vital consumer protection, ensuring that patients receive full credit for their insulin payments towards their annual out-of-pocket limits, preventing them from paying more than intended.
Case against: No specific opposition is typically raised against this provision, as it is a standard consumer protection measure that aligns with broader healthcare policy goals.
Estimated impact: Ensures that patients' capped insulin costs contribute to their overall financial protection under their health plan, preventing unexpected additional expenses.
Out-of-Network Providers: Clarifies that the bill does not require plans with a network of providers to cover selected insulin products delivered by an out-of-network provider, nor does it preclude them from imposing higher cost-sharing for such out-of-network services.
Section 2(a), (b), (c) - new sections 2799A-11(c), 9826(c), 726(c)
Why it matters:This is standard legislative practice to respect existing plan designs and network structures, rather than an attempt to obscure.
Case for: Proponents would argue this maintains the integrity of managed care networks, allowing plans to incentivize in-network care and manage costs effectively, which ultimately benefits all enrollees through potentially lower premiums.
Case against: Critics might argue that this could create a barrier to access for individuals who, for various reasons (e.g., rural location, specialist needs), must rely on out-of-network providers for their insulin, potentially undermining the bill's affordability goals for some.
Estimated impact: Preserves health plans' ability to manage costs and networks, but may result in higher costs for individuals who access insulin through out-of-network providers.