Affordable Insulin Now Act of 2026
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This bill would cap insulin cost-sharing at $35 for private insurance and fund a program to provide $35 insulin to uninsured individuals.
What it does
This bill would limit monthly cost-sharing for insulin under private health insurance to the lesser of $35 or 25% of the plan's negotiated price starting in 2027. Additionally, the legislation proposes a program where the Department of Health and Human Services would reimburse pharmacies and providers to ensure individuals without insurance can obtain a 30-day supply of insulin for no more than $35 out-of-pocket.
Who is affected
This bill affects individuals with private health insurance who require insulin, as well as uninsured individuals who will gain access to insulin through a new federal subsidy program. It also impacts the Department of Health and Human Services (HHS), which must manage agreements and payments for the uninsured program. Additionally, private health insurance plans, pharmacies, and health care providers are affected by new cost-sharing limits and reimbursement structures.
Key provisions
- Private health insurance cost-sharing cap. Beginning in 2027, the bill limits out-of-pocket costs for a month's supply of selected insulin products under private insurance to the lesser of $35 or 25% of the plan's negotiated price.
- Insulin access for uninsured individuals. The Department of Health and Human Services is required to establish agreements with pharmacies and health care providers to supply insulin to individuals who do not have insurance.
- Federal reimbursement for pharmacy costs. The Department of Health and Human Services must pay participating pharmacies or providers the difference between an uninsured individual's out-of-pocket cost for a 30-day supply and $35.
Fiscal impact
Not applicable: No CBO cost estimate available
Effective dates
The cost-sharing caps for insulin products under private health insurance plans are scheduled to begin in 2027.
Relationship to existing law
The bill modifies cost-sharing requirements for private health insurance plans and establishes a new Department of Health and Human Services (HHS) payment program for pharmacies and health care providers to subsidize insulin costs for uninsured individuals.
Stated purpose
The bill aims to reduce the financial burden of insulin by capping out-of-pocket costs for individuals with private health insurance and establishing a federal program to subsidize insulin costs for uninsured individuals.