Affordable Insulin Now Act

Bill Number: H.R. 6255
Origin Chamber: House
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-11-21: 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: 2026-06-26T08:07:01Z

AI-Generated Summary

Purpose

The Affordable Insulin Now Act aims to reduce out-of-pocket costs for insulin, a critical medication for people with diabetes, by establishing federal requirements that limit cost-sharing (the portion patients pay, such as copays or coinsurance) for certain insulin products in health insurance plans. It seeks to make insulin more accessible without applying deductibles (the amount patients must pay before insurance covers costs) and by capping patient expenses.

Key Provisions

Effective Date and Scope: Applies to group health plans (employer-sponsored insurance) and health insurance issuers offering group or individual coverage for plan years starting on or after January 1, 2026. It amends three major laws: the Public Health Service Act (PHSA), the Internal Revenue Code (IRC), and the Employee Retirement Income Security Act (ERISA).
Coverage Requirements for Selected Insulin Products:
Plans and issuers must cover "selected insulin products," defined as at least one option for each type of insulin (e.g., rapid-acting, long-acting, premixed) and dosage form (e.g., vial, pump, inhaler), chosen by the plan or issuer when available.
No deductibles can be applied to these products.
Cost-sharing is limited to the lesser of:
$35 per 30-day supply, or
25% of the negotiated price (after discounts or rebates from manufacturers, pharmacies, or pharmacy benefit managers—intermediaries that negotiate drug prices).
Insulin is defined as products licensed by the FDA (Food and Drug Administration) under biologics regulations and actively marketed, including biosimilars (similar versions of brand-name drugs).
Exceptions and Flexibility:
Plans with provider networks (in-network doctors and pharmacies) are not required to cover out-of-network insulin at these rates and can charge more for out-of-network services.
Non-selected insulin products can have standard cost-sharing if not otherwise required by law.
Any cost-sharing paid for selected insulin counts toward the patient's overall deductible and out-of-pocket maximum (the yearly limit on patient expenses).
Impact on Affordable Care Act (ACA) Plans:
Exempts selected insulin from affecting the "actuarial value" (a measure of how much a plan covers costs overall) of ACA-qualified plans.
Extends requirements to "catastrophic" plans (basic ACA plans for younger people or those with hardships), providing insulin coverage before the patient reaches the annual out-of-pocket limit.

Significant Changes to Existing Law

Builds on prior insulin cost caps (e.g., a $35 monthly cap for Medicare Part D since 2023) by extending similar protections to private employer and individual market plans, which were not previously covered this way.
Introduces a new percentage-based cap (25% of net negotiated price) as an alternative to the flat $35 limit, allowing flexibility if drug prices are low.
Explicitly includes catastrophic plans, which previously had limited preventive coverage before the annual limit.
Adds cross-references across PHSA, IRC, and ERISA to ensure uniform enforcement, without altering broader ACA cost-sharing rules for other drugs or services.

Potential Impacts

On Citizens: Lowers financial barriers for the approximately 8.4 million Americans using insulin, potentially improving adherence to treatment, reducing emergency care needs, and saving patients hundreds of dollars monthly on copays.
On Government Agencies: Increases enforcement roles for the Departments of Health and Human Services (HHS), Labor (DOL), and Treasury (via IRS), including monitoring compliance and handling disputes; may raise administrative costs but reduce long-term healthcare spending on diabetes complications.
On Health Insurers and Plans: Could slightly increase premiums as plans absorb more upfront costs (no deductibles), but negotiated price concessions might offset this; encourages selection of lower-cost insulin options.
On International Relations: Minimal direct impact, though it may influence U.S. drug pricing negotiations with global pharmaceutical companies, many of which are foreign-based.

Main Stakeholders Affected

Patients with Diabetes: Primary beneficiaries, especially those on private insurance, gaining predictable low costs for essential insulin.
Health Insurance Issuers and Group Health Plans: Must comply with new coverage rules, affecting product design and pricing strategies.
Employers: As sponsors of group plans, they may face higher plan costs but benefit from healthier workforces.
Pharmacy Benefit Managers (PBMs): Impacted by requirements to account for all price concessions in cost-sharing calculations, potentially altering rebate and negotiation practices.
Pharmaceutical Manufacturers: Face pressure to lower list prices or increase rebates to keep net prices eligible for the 25% cap.
Government Regulators (HHS, DOL, IRS): Responsible for implementation, guidance, and penalties for non-compliance.

Notable Legal, Constitutional, or Political Implications

Legal: Strengthens patient protections under federal health laws by mandating specific drug coverage, enforceable through civil penalties (fines) or plan disqualification; aligns with ACA's focus on affordability but could lead to litigation if insurers challenge the administrative burden or price concession calculations.
Constitutional: Likely upheld under Congress's authority to regulate interstate commerce (health insurance markets), similar to ACA rulings; no apparent free speech or property rights issues, though manufacturers might argue it interferes with pricing freedom.
Political: Promotes healthcare affordability, a bipartisan priority, but may spark debate over government intervention in private markets versus industry costs; could set precedent for capping other high-cost drugs, influencing future legislation on drug pricing.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Craig, Angie [D-MN-2]

Cosponsors (9)

Rep. McBath, Lucy [D-GA-6], Rep. Horsford, Steven [D-NV-4], Rep. Landsman, Greg [D-OH-1], Rep. Schrier, Kim [D-WA-8], Rep. Davids, Sharice [D-KS-3], Rep. Stevens, Haley M. [D-MI-11], Rep. Carbajal, Salud O. [D-CA-24], Rep. Vindman, Eugene Simon [D-VA-7], Rep. McIver, LaMonica [D-NJ-10]

Recent Actions

2025-11-21: 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.
2025-11-21: 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.
2025-11-21: 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.
2025-11-21: Introduced in House
2025-11-21: Introduced in House

Bill Versions

Affordable Insulin Now Act — issued 2025-11-21 — PDF (11 pages)