INSULIN Act of 2026 (S. 4189)

Summary

Makes insulin more affordable by limiting monthly costs for people with insurance and creating new programs to help uninsured people get low-cost insulin.

What problem does this solve?

Many people with diabetes cannot afford insulin, which is a life-saving medicine. This bill caps the monthly cost of insulin for insured people and creates programs to help uninsured people get it at a lower price.

What does this bill do?

Caps monthly insulin costs for insured people

Limits cost-sharing for a 30-day supply of insulin to $35 for individuals with private health insurance, starting in 2027. This cap applies even if the deductible has not been met.

Requires PBMs to pass on insulin rebates

Forces Pharmacy Benefit Managers (PBMs) and other third parties to give 100% of the rebates and fees they get from insulin makers back to the health plan.

Creates a pilot program for the uninsured

Starts a 5-year pilot program that gives grants to 10 states to help uninsured people get insulin for no more than $35 per month.

Speeds up approval for cheaper insulin alternatives

Creates a faster process for the FDA to review and approve biosimilar insulin products, which are like generic versions, to increase competition and lower prices.

Establishes a resource center for the uninsured

Awards a grant to create a national resource center and a 24/7 hotline to help uninsured people find and enroll in programs that offer low-cost insulin.

Lowers the insulin cap based on net price

Starting in 2028, the monthly insulin cap will be the lower of $35 or 25% of the health plan's negotiated price after all rebates and discounts are applied.

Limits prior authorization for insulin

Prohibits health plans from requiring prior authorization or other medical management rules for selected insulin products, unless it is for safety reasons.

Requires a study on insulin competition

Directs the Secretary of Health and Human Services to study the causes of delays in getting new insulin products to market and report to Congress on how to increase competition.

Who does this affect?

People with diabetes
Uninsured individuals
Health insurance providers and PBMs

What is the real world impact?

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Makes insulin more affordable

Addresses the high cost of insulin, a major public health issue, by directly limiting how much patients have to pay out-of-pocket each month.

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Increases transparency of drug pricing

Forces Pharmacy Benefit Managers (PBMs) to pass all insulin rebates to health plans. This aims to reduce the influence of these middlemen, who are often blamed for high drug prices.

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Could increase insurance premiums

Capping patient costs doesn't lower the drug's list price. Insurance companies might raise monthly premiums for everyone to cover the difference, shifting the cost rather than eliminating it.

When does this start?

Most major provisions, including the cap on insulin costs for insured individuals, would begin for health plan years starting on or after January 1, 2027.

Insulin cost cap begins

For plan years starting on or after January 1, 2027, health plans must cap patient costs for insulin at $35 for a 30-day supply.

Adjusted insulin cost cap

For plan years starting on or after January 1, 2028, the insulin cost cap becomes the lesser of $35 or 25% of the net negotiated price.

Insulin competition report

Not later than 1 year after the bill is enacted, the Secretary of Health and Human Services must submit a report to Congress on insulin market competition.

GAO study on uninsured

Not later than 2 years after the bill is enacted, the Government Accountability Office (GAO) must issue a report on uninsured individuals who use insulin.