INSULIN Act of 2026

Lower Out-of-Pocket Costs for Insured Individuals: Group health plans and insurance issuers must provide coverage for selected insulin products without applying a deductible and with cost-sharing capped at $35 per 30-day supply for plan years before 2028, or a lower amount starting in 2028 (Section 101/Section 2729A).

Removal of Medical Management Barriers: Health plans are prohibited from imposing prior authorization or other medical management requirements on selected insulin products, except when clinically justified for safety and quantity limits (Section 101/Section s 2729A(f)).

Increased Rebates to Health Plans: Pharmacy benefit managers and other entities must remit 100 percent of all insulin-related rebates and discounts back to the group health plan (Section 201/Section 2799A-13).

Support for Uninsured Individuals: A 5-year pilot program will award grants to 10 states to help uninsured people purchase or dispense insulin through health centers and pharmacies (Section 401/Section 399V-8).

Access to Information and Assistance: The bill funds a resource center and a 24/7 hotline to help uninsured individuals find assistance programs and navigate access to insulin (Section 403/Section 8).

Faster Access to Competitors: The bill allows the Secretary to expedite the development and review of competitive biosimilar products to increase market competition (Section 302/Section 351(k)(10)).

Potential for Higher Costs for Out-of-Network Care: While the bill limits costs for selected products within a network, insurance plans are not required to provide these benefits for out-of-network providers and may impose higher cost-sharing for those services (Section 101/Section 2729A(c)).

Cost-Sharing Caps May Decrease Over Time: For plan years beginning on or after January 1, 2028, the $35 cap may be lowered to 25 percent of the negotiated price of the selected insulin product net of concessions (Section 101/Section 2729A(a)(2)(B)).