Making Insulin Affordable for All Children Act
Sponsored By: Representative Landsman
Introduced
Summary
Caps insulin cost-sharing for people 26 and younger. This bill would require private group and individual health plans to cover selected insulin products without applying a deductible and to limit cost-sharing to the lesser of $35 per 30-day supply or 25% of the negotiated price, starting in plan years on or after January 1, 2026. It would align those rules across the Public Health Service Act, the Employee Retirement Income Security Act, the Internal Revenue Code, and the Affordable Care Act and give HHS, Labor, and Treasury authority to issue implementation guidance.
Show full summary
- Families with young insulin users would face lower out-of-pocket costs at the pharmacy because eligible insulin would have no deductible and a cap of $35 or 25% per 30-day supply.
- People age 26 and younger who need insulin would get coverage of at least one dosage form for each major insulin type chosen by the plan, and amounts paid would count toward deductibles and out-of-pocket limits.
- Employers and ERISA-covered plans would need to follow the same $35 or 25% cap and the bill adds a new ERISA section to enforce that requirement.
- Marketplace and catastrophic plan rules would change so qualified health plans treat selected insulin coverage consistently with the new cost-sharing limits.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 0 costs, 2 mixed.
Lower insulin costs for under 26 enrollees
Starting with plan years on or after January 1, 2026, private and job-based plans would have to cover selected insulin for enrollees age 26 or younger. For those products, you would owe no deductible and no more than the lesser of $35 or 25% of the plan’s negotiated price for a 30-day supply, after all rebates and discounts (including those to pharmacy benefit managers). What you pay would still count toward your deductible and out-of-pocket limit. Plans would pick the “selected” insulin options and must include at least one for each insulin type and form, when available. The cap would not apply to people over 26 or to non-selected insulin, and catastrophic plans would have to cover selected insulin for under‑26 before other cost-sharing applies up to the plan’s annual limit.
Insulin deductible break will not change plan value
If enacted, when insurers calculate actuarial value for marketplace plans, they would not be allowed to count the insulin deductible exemption. Plans could respond by adjusting other cost-sharing or premiums. This would apply for plan years starting on or after January 1, 2026.
Agencies could use guidance to implement
If enacted, the Health and Human Services, Labor, and Treasury Secretaries could use guidance or program instructions to carry out these insulin rules. Any effect on families would depend on the details these agencies issue.
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Sponsors & CoSponsors
Sponsor
Landsman
OH • D
Cosponsors
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 4/3/2025
Dean (PA)
PA • D
Sponsored 4/3/2025
McGarvey
KY • D
Sponsored 4/3/2025
Thompson (MS)
MS • D
Sponsored 4/3/2025
Gottheimer
NJ • D
Sponsored 4/3/2025
Deluzio
PA • D
Sponsored 6/3/2025
Johnson (TX)
TX • D
Sponsored 7/22/2025
Roll Call Votes
No roll call votes available for this bill.
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