Affordable Insulin Now Act of 2026
- Bill Number
- S. 4512
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-05-13: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- Last Updated
- 2026-06-08T19:52:41Z
AI-Generated Summary
Purpose The Affordable Insulin Now Act of 2026 aims to limit out-of-pocket costs for certain insulin products under private health plans and to create a federal program that helps health care providers and pharmacies supply discounted insulin to uninsured individuals.
Key Provisions
- Cost-sharing limits for private plans: Starting January 1, 2027, group health plans and health insurance issuers must cover selected insulin products without applying a deductible. Cost-sharing is capped at the lesser of $35 or 25 percent of the negotiated price (net of concessions) per 30-day supply.
- Selected insulin products: Plans must include at least one product from each dosage form and type (such as rapid-acting, long-acting) when available.
- Application to existing law: These rules apply to plans under the Public Health Service Act, Employee Retirement Income Security Act, and Internal Revenue Code. Any cost-sharing counts toward deductibles and out-of-pocket maximums.
- Catastrophic and qualified health plans: Insulin coverage begins before the annual out-of-pocket limit is met, and exemptions from deductibles do not affect actuarial value calculations.
- Uninsured program: The Secretary of Health and Human Services must establish a reimbursement program. Qualifying providers and pharmacies receive payment equal to the difference between the individual's out-of-pocket cost and $35 per 30-day supply. Entities must agree not to bill the individual further and meet other standards.
- Sense of Congress: Future legislation should offset any federal costs from the Act.
Significant Changes to Existing Law The Act adds new sections to the Public Health Service Act (section 2799A-12), Employee Retirement Income Security Act (section 727), and Internal Revenue Code (section 9827). It modifies the Affordable Care Act's provisions on cost-sharing, actuarial value, and catastrophic plan coverage. These changes impose uniform federal standards on private plans that previously had greater flexibility in insulin cost-sharing.
Potential Impacts
- Government agencies: The Departments of Health and Human Services, Labor, and Treasury gain authority to issue sub-regulatory guidance for implementation. HHS must administer the new uninsured reimbursement program.
- Citizens: Insured individuals may face lower and more predictable costs for selected insulin products. Uninsured individuals may gain access to insulin at a maximum out-of-pocket cost of $35 per 30-day supply through participating providers.
- International relations: No direct effects are specified in the legislation.
Main Stakeholders Affected
- Private health plans and health insurance issuers.
- Health care providers and pharmacies that choose to participate in the uninsured program.
- Individuals with private health coverage or no coverage who use insulin.
- Federal agencies responsible for oversight and reimbursement.
- Congress, which is encouraged to enact offsetting legislation.
Notable Legal, Constitutional, or Political Implications The Act extends federal requirements to employer-sponsored and individual market plans, potentially preempting some state variations in cost-sharing rules. It does not alter existing out-of-network cost-sharing flexibility or require coverage of non-selected insulin products. The legislation includes a non-binding sense of Congress regarding federal spending offsets but creates no new constitutional mandates or international obligations.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Recent Actions
- 2026-05-13: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
- 2026-05-13: Introduced in Senate
Bill Versions
- Affordable Insulin Now Act of 2026 — issued 2026-05-13 — PDF (13 pages)