United States S 4512: Affordable Insulin Now Act of 2026

Bill Text

II
119TH CONGRESS
2D SESSION S. 4512
To provide for appropriate cost-sharing for insulin products covered under
private health plans, and to establish a program to support health care
providers and pharmacies in providing discounted insulin products to
uninsured individuals.
IN THE SENATE OF THE UNITED STATES
MAY 13, 2026
Mr. KENNEDY introduced the following bill; which was read twice and referred
to the Committee on Health, Education, Labor, and Pensions
A BILL
To provide for appropriate cost-sharing for insulin products
covered under private health plans, and to establish a
program to support health care providers and pharmacies
in providing discounted insulin products to uninsured
individuals.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Affordable Insulin Now 4
Act of 2026’’. 5
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•S 4512 IS
SEC. 2. APPROPRIATE COST-SHARING FOR INSULIN PROD-1
UCTS COVERED UNDER PRIVATE HEALTH 2
PLANS. 3
(a) IN GENERAL.—Part D of title XXVII of the Pub-4
lic Health Service Act (42 U.S.C. 300gg–111 et seq.) is 5
amended by adding at the end the following: 6
‘‘SEC. 2799A–12. REQUIREMENTS WITH RESPECT TO COST- 7
SHARING FOR CERTAIN INSULIN PRODUCTS. 8
‘‘(a) IN GENERAL.—For plan years beginning on or 9
after January 1, 2027, a group health plan or health in-10
surance issuer offering group or individual health insur-11
ance coverage shall provide coverage of selected insulin 12
products, and with respect to such products, shall not— 13
‘‘(1) apply any deductible; or 14
‘‘(2) impose any cost-sharing in excess of the 15
lesser of, per 30-day supply— 16
‘‘(A) $35; or 17
‘‘(B) the amount equal to 25 percent of 18
the negotiated price of the selected insulin prod-19
uct net of all price concessions received by or on 20
behalf of the plan or coverage, including price 21
concessions received by or on behalf of third- 22
party entities providing services to the plan or 23
coverage, such as pharmacy benefit manage-24
ment services. 25
‘‘(b) DEFINITIONS.—In this section: 26
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•S 4512 IS
‘‘(1) SELECTED INSULIN PRODUCTS.—The term 1
‘selected insulin products’ means at least one of each 2
dosage form (such as vial, pump, or inhaler dosage 3
forms) of each different type (such as rapid-acting, 4
short-acting, intermediate-acting, long-acting, ultra 5
long-acting, and premixed) of insulin, when avail-6
able, as selected by the group health plan or health 7
insurance issuer. 8
‘‘(2) INSULIN DEFINED.—The term ‘insulin’ 9
means insulin that is licensed under subsection (a) 10
or (k) of section 351 and continues to be marketed 11
under such section. 12
‘‘(c) OUT-OF-NETWORK PROVIDERS.—Nothing in 13
this section requires a plan or issuer that has a network 14
of providers to provide benefits for selected insulin prod-15
ucts described in this section that are delivered by an out- 16
of-network provider, or precludes a plan or issuer that has 17
a network of providers from imposing higher cost-sharing 18
than the levels specified in subsection (a) for selected insu-19
lin products described in this section that are delivered 20
by an out-of-network provider. 21
‘‘(d) RULE OF CONSTRUCTION.—Subsection (a) shall 22
not be construed to require coverage of, or prevent a group 23
health plan or health insurance coverage from imposing 24
cost-sharing other than the levels specified in subsection 25
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•S 4512 IS
(a) on, insulin products that are not selected insulin prod-1
ucts, to the extent that such coverage is not otherwise re-2
quired and such cost-sharing is otherwise permitted under 3
Federal and applicable State law. 4
‘‘(e) APPLICATION OF COST-SHARING TOWARDS 5
DEDUCTIBLES AND OUT-OF-POCKET MAXIMUMS.—Any 6
cost-sharing payments made pursuant to subsection (a)(2) 7
shall be counted toward any deductible or out-of-pocket 8
maximum that applies under the plan or coverage.’’. 9
(b) NO EFFECT ON OTHER COST-SHARING.—Section 10
1302(d)(2) of the Patient Protection and Affordable Care 11
Act (42 U.S.C. 18022(d)(2)) is amended by adding at the 12
end the following new subparagraph: 13
‘‘(D) SPECIAL RULE RELATING TO INSU-14
LIN COVERAGE.—The exemption of coverage of 15
selected insulin products (as defined in section 16
2799A–12(b) of the Public Health Service Act) 17
from the application of any deductible pursuant 18
to section 2799A–12(a)(1) of such Act, section 19
727(a)(1) of the Employee Retirement Income 20
Security Act of 1974, or section 9827(a)(1) of 21
the Internal Revenue Co