Affordable Insulin Now Act
Sponsored By: Representative Craig
Introduced
Summary
Caps out-of-pocket insulin costs at the lesser of $35 per 30-day supply or 25% of the negotiated price. This bill would require no deductible for covered insulin and extend that cap to private group plans, ERISA plans, ACA marketplace coverage, and tax-qualified plans for plan years beginning after January 1, 2026.
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- Patients and families: Payments for selected insulin products would count toward plan deductibles and out-of-pocket maximums, reducing long-term cost exposure for people who use insulin.
- Health plans and employers: Plans would have to cover a defined set of "selected insulin products" and include at least one dosage form of each insulin type (for example rapid-acting, long-acting, and premixed). The cost-sharing cap would be based on the negotiated price after price concessions, including amounts realized through pharmacy benefit managers.
- Catastrophic and network rules: Catastrophic plans would be required to cover selected insulin before an enrollee reaches the annual limit. Plans are not compelled to cover selected insulin delivered by out-of-network providers and may apply higher cost-sharing for out-of-network delivery.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 1 benefits, 1 costs, 1 mixed.
No deductible, cost cap for selected insulin
If enacted, private health plans would have to cover selected insulin with no deductible. Your cost per 30-day supply would be the lesser of $35 or 25% of the plan’s negotiated price after all price concessions (like rebates and discounts). These payments would count toward your deductible and out-of-pocket limit. Plans would choose the specific “selected insulin products.” They must include at least one form (vial, pump, or inhaler) for each insulin type when available, and only FDA-licensed insulin would qualify. This would start for plan years beginning on or after January 1, 2026.
Out-of-network insulin may cost more
If enacted, plans with a provider network would not have to cover selected insulin from out-of-network providers. They could charge more than the in-network cap or refuse coverage. This would apply for plan years starting on or after January 1, 2026.
Marketplace plan ratings ignore insulin waiver
If enacted, when Marketplace plans set their metal level, they would ignore the special rule that waives deductibles for selected insulin products. This could change plan pricing or metal labels, depending on insurer and regulator choices. It would not change the insulin cost cap itself.
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Sponsors & CoSponsors
Sponsor
Craig
MN • D
Cosponsors
McBath
GA • D
Sponsored 11/21/2025
Horsford
NV • D
Sponsored 11/21/2025
Landsman
OH • D
Sponsored 11/21/2025
Schrier
WA • D
Sponsored 11/21/2025
Davids (KS)
KS • D
Sponsored 1/8/2026
Stevens
MI • D
Sponsored 1/8/2026
Roll Call Votes
No roll call votes available for this bill.
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