Making Insulin Affordable for All Children Act
- Bill Number
- H.R. 2636
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-04-03: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-05-21T08:08:31Z
AI-Generated Summary
Purpose of the Legislation
The "Making Insulin Affordable for All Children Act" (H.R. 2636) aims to reduce the financial burden of insulin for young people by limiting out-of-pocket costs in private health insurance plans. It targets individuals aged 26 or younger who rely on insulin to manage diabetes, ensuring access to essential medications without high deductibles or excessive copays.
Key Provisions
- Coverage Requirements: Starting with plan years on or after January 1, 2026, group health plans and health insurance issuers offering group or individual coverage must provide coverage for "selected insulin products" for enrollees 26 years of age or younger.
- No deductibles can be applied to these products.
- Cost-sharing (such as copays or coinsurance) is capped at the lesser of:
- $35 per 30-day supply, or
- 25% of the negotiated price of the insulin product (after discounts from manufacturers or pharmacy benefit managers).
- Definition of Selected Insulin Products: Plans or issuers must select and cover at least one insulin product in each available dosage form (e.g., vial, pump, inhaler) and type (e.g., rapid-acting, long-acting, premixed). "Insulin" refers to FDA-licensed products that are still marketed.
- Flexibility for Non-Selected Products: The law does not require coverage of non-selected insulin products or impose these limits on insulin for individuals over 26; standard plan rules apply if coverage is provided.
- Counting Toward Limits: Any required cost-sharing counts toward the plan's overall deductible and out-of-pocket maximum.
- Application to Specific Plans:
- Extends to catastrophic health plans under the Affordable Care Act (ACA), providing coverage before the annual out-of-pocket limit is reached.
- Ensures the insulin exemption does not affect the "actuarial value" (a measure of a plan's generosity) when certifying qualified health plans.
- Implementation: Federal agencies (Health and Human Services, Labor, and Treasury) can use guidance or instructions to enforce without full rulemaking.
The bill amends the Public Health Service Act, Employee Retirement Income Security Act (ERISA), Internal Revenue Code, and ACA to align these rules across federal health laws.
Significant Changes to Existing Law
- New Mandates on Private Plans: Introduces specific insulin cost-sharing limits for youth, building on but expanding prior laws like the 2022 Inflation Reduction Act's $35 cap for Medicare insulin (which did not apply to private plans or those under 65).
- ERISA and Tax Code Alignment: Adds parallel sections to ERISA (governing employer plans) and the Internal Revenue Code (affecting tax-qualified plans) to ensure uniform application, closing gaps in coverage for employer-sponsored insurance.
- ACA Adjustments: Modifies catastrophic plans to include insulin coverage pre-deductible and clarifies that these exemptions do not alter plan value calculations, preventing unintended shifts in premium subsidies or plan design.
- No changes to Medicare, Medicaid, or public plans; focuses solely on private group and individual markets.
Potential Impacts
- On Citizens: Lowers insulin costs for an estimated millions of young people with diabetes (Type 1 or Type 2), potentially improving adherence to treatment, reducing emergency care needs, and easing family financial strain. For example, a 30-day supply could cost no more than $35 out-of-pocket, regardless of the drug's list price.
- On Government Agencies: Departments of Health and Human Services, Labor, and Treasury gain enforcement responsibilities, possibly increasing administrative workload for monitoring compliance through audits or guidance. No direct federal funding is appropriated.
- On Health Plans and Insurers: May raise short-term costs for plans due to waived deductibles, potentially leading to slight premium increases, but encourages selection of lower-cost insulins. Pharmacy benefit managers must report net prices accurately.
- International Relations: No direct impact, as the bill addresses domestic private insurance without affecting trade, drug imports, or global health policy.
Main Stakeholders Affected
- Primary Beneficiaries: Individuals 26 years of age or younger with diabetes requiring insulin, including children, young adults, and their families.
- Health Insurers and Plans: Group health plans (employer-sponsored) and individual market issuers must adjust formularies and cost structures.
- Employers: Those offering group coverage under ERISA may face compliance costs but benefit from healthier young employees.
- Pharmaceutical Manufacturers: Insulin makers (e.g., producers of licensed biologics) could see increased utilization of selected products, influencing pricing negotiations.
- Healthcare Providers: Doctors and clinics may see better patient outcomes from affordable access, reducing barriers to care.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens federal oversight of private health benefits under existing frameworks like the ACA and ERISA, potentially inviting lawsuits if plans challenge the cost caps as preempting state laws (though the bill allows state-permitted cost-sharing where applicable). The "rule of construction" preserves flexibility to avoid overreach.
- Constitutional: No apparent challenges; it regulates interstate commerce in health insurance, a well-established federal power, without infringing on free speech, privacy, or equal protection.
- Political: Advances bipartisan goals of healthcare affordability, focusing on youth to build support for chronic disease management. Could set precedent for expanding drug cost caps beyond Medicare, influencing future debates on pharmaceutical pricing and insurance reform. Referred to multiple committees (Energy and Commerce, Ways and Means, Education and Workforce), indicating broad jurisdictional review.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (9)
Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Dean, Madeleine [D-PA-4], Rep. McGarvey, Morgan [D-KY-3], Rep. Thompson, Bennie G. [D-MS-2], Rep. Gottheimer, Josh [D-NJ-5], Rep. Deluzio, Christopher R. [D-PA-17], Rep. Johnson, Julie [D-TX-32], Rep. Craig, Angie [D-MN-2], Rep. Carter, Troy A. [D-LA-2]
Recent Actions
- 2025-04-03: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-03: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-03: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-04-03: Introduced in House
- 2025-04-03: Introduced in House
Bill Versions
- Making Insulin Affordable for All Children Act — issued 2025-04-03 — PDF (11 pages)