S.Amdt. 6075

The INSULIN Act of 2026 is an amendment to bill S. 4784. Its primary purpose is to increase the affordability and accessibility of insulin for people with health insurance and those who are uninsured.

The amendment aims to add the following changes:

Patient Protections and Cost-Sharing

• For plan years starting January 1, 2027, group and individual health plans must cover selected insulin products.
• Plans cannot apply deductibles to these products.
• Cost-sharing is capped at $35 per 30-day supply before January 1, 2028.
• Starting January 1, 2028, the cap is the lesser of $35 or 25 percent of the negotiated price (after price concessions).
• It limits the use of prior authorizations or medical management requirements unless they are clinically justified for safety or quantity limits.

Transparency and Competition

• Pharmacy benefit managers and third-party administrators must send 100 percent of rebates and other remuneration from manufacturers back to the group health plan.
• It creates a process to expedite the review and development of competitive biosimilar therapies when there is inadequate competition (fewer than 3 licensed biosimilars).
• It establishes new rules to prevent the use of "citizen petitions" as a way to delay the approval of generic or biosimilar insulin.
• It requires a study and report to Congress on the causes of delays in getting insulin products to market.

Support for Uninsured Individuals

• Establishes a 5-year pilot program awarding grants to 10 States to help uninsured people get affordable insulin (defined as $35 or less per 1-month supply).
• Authorizes $100,000,000 for the pilot program in fiscal year 2027.
• Directs the GAO to study the characteristics of uninsured individuals who use insulin.
• Creates a grant-funded resource center and 24/7 hotline to help uninsured individuals find assistance programs and enroll in health insurance.