INSULIN Act of 2026
Sponsored By: Senator Jeanne Shaheen
Introduced
Summary
This bill would cap out-of-pocket insulin costs for most commercial and exchange-based plans while also forcing PBMs to pass rebates to plans and speeding biosimilar competition to lower drug prices overall.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 3 benefits, 0 costs, 2 mixed.
Lower insulin costs for insured people
If enacted, for plan years starting Jan 1, 2027, insurers and group health plans would cover selected insulin without applying a deductible. For plan years beginning before Jan 1, 2028 you would pay at most $35 per 30-day supply. For plan years beginning on or after Jan 1, 2028 cost-sharing would be the lesser of $35 or 25% of the negotiated price net of all price concessions. Any cost-sharing you pay would count toward your deductible and out-of-pocket maximums, and plans could not require prior authorization for these insulins except for safety or reasonable quantity limits. The bill would also update rules so these protections apply to retiree and certain small-group plans, and it would require plans to ignore the insulin deductible exemption when calculating a marketplace plan's actuarial value for plan years starting Jan 1, 2028, which could affect plan design or premiums.
Help for uninsured insulin users
If enacted, HHS would run a 5-year pilot giving grants to 10 states to make insulin affordable for uninsured people, aiming for out-of-pocket costs of $35 or less per one-month supply. The bill would authorize $100 million for fiscal year 2027 for the pilot. HHS would also fund grants to set up a national insulin resource center and a 24/7 hotline to help uninsured people find and enroll in assistance programs; that resource center program is authorized at $2 million per year for fiscal years 2027 through 2032.
PBMs must pass insulin rebates to plans
If enacted, pharmacy benefit managers and similar administrators would have to remit 100% of rebates, fees, discounts, and other remuneration tied to insulin back to the group health plan. Those amounts would have to be sent no later than 90 days after the period ends, fully disclosed to the plan sponsor, and auditable at least once per plan year. Returning these funds to plans could increase plan assets or help lower premiums or member costs depending on employer or issuer decisions.
Speed up biosimilar competition
If enacted, the Secretary could designate a biosimilar as a 'competitive biosimilar therapy' when there are fewer than three licensed biosimilars for the same product. Sponsors could request this designation before or with their application and the Secretary would have to act within 60 calendar days. Designation would trigger expedited meetings, timely review, senior staff involvement, a cross-disciplinary project lead, and faster inspections or reinspections after a firm attests to fixes. The bill would also let the agency consider listed factors to identify citizen petitions filed mainly to delay generic or biosimilar approvals.
Faster agency rollout and paperwork waiver
If enacted, HHS, Labor, and Treasury would be allowed to implement these insulin-related rules for plan years starting on or after Jan 1, 2027 by guidance or other nonrulemaking means through Jan 1, 2030. The Paperwork Reduction Act would not apply to these provisions. Allowing subregulatory implementation could speed when consumers see protections, but it would reduce the usual public notice-and-comment process and paperwork review.
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Sponsors & CoSponsors
Sponsor
Jeanne Shaheen
NH • D
Cosponsors
Susan Collins
ME • R
Sponsored 3/25/2026
Raphael Warnock
GA • D
Sponsored 3/25/2026
John Kennedy
LA • R
Sponsored 3/25/2026
Jacky Rosen
NV • D
Sponsored 3/25/2026
Tommy Tuberville
AL • R
Sponsored 3/25/2026
Angus King
ME • I
Sponsored 3/25/2026
Lisa Murkowski
AK • R
Sponsored 3/25/2026
Mark Kelly
AZ • D
Sponsored 3/25/2026
Chuck Grassley
IA • R
Sponsored 3/25/2026
Tammy Baldwin
WI • D
Sponsored 3/25/2026
Katie Britt
AL • R
Sponsored 3/25/2026
Roll Call Votes
No roll call votes available for this bill.
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