H.R. 6255

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6255 Introduced in House (IH)]

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119th CONGRESS
1st Session
H. R. 6255

To amend title XXVII of the Public Health Service Act, the Internal 
Revenue Code of 1986, and the Employee Retirement Income Security Act 
of 1974 to establish requirements with respect to cost-sharing for 
certain insulin products, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

November 21, 2025

Ms. Craig (for herself, Mrs. McBath, Mr. Horsford, Mr. Landsman, and 
Ms. Schrier) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees on 
Ways and Means, and Education and Workforce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
of such provisions as fall within the jurisdiction of the committee 
concerned

_______________________________________________________________________

A BILL

To amend title XXVII of the Public Health Service Act, the Internal 
Revenue Code of 1986, and the Employee Retirement Income Security Act 
of 1974 to establish requirements with respect to cost-sharing for 
certain insulin products, and for other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Affordable Insulin Now Act''.

SEC. 2. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR INSULIN PRODUCTS.

(a) PHSA.--Part D of title XXVII of the Public Health Service Act 
(42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the 
following new section:

``SEC. 2799A-11. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN 
INSULIN PRODUCTS.

``(a) In General.--For plan years beginning on or after January 1, 
2026, a group health plan or health insurance issuer offering group or 
individual health insurance coverage shall provide coverage of selected 
insulin products, and with respect to such products, shall not--
``(1) apply any deductible; or
``(2) impose any cost-sharing in excess of the lesser of, 
per 30-day supply--
``(A) $35; or
``(B) the amount equal to 25 percent of the 
negotiated price of the selected insulin product net of 
all price concessions received by or on behalf of the 
plan or coverage, including price concessions received 
by or on behalf of third-party entities providing 
services to the plan or coverage, such as pharmacy 
benefit management services.
``(b) Definitions.--In this section:
``(1) Selected insulin products.--The term `selected 
insulin products' means at least one of each dosage form (such 
as vial, pump, or inhaler dosage forms) of each different type 
(such as rapid-acting, short-acting, intermediate-acting, long-
acting, ultra long-acting, and premixed) of insulin (as defined 
below), when available, as selected by the group health plan or 
health insurance issuer.
``(2) Insulin defined.--The term `insulin' means insulin 
that is licensed under subsection (a) or (k) of section 351 and 
continues to be marketed under such section, including any 
insulin product that has been deemed to be licensed under 
section 351(a) pursuant to section 7002(e)(4) of the Biologics 
Price Competition and Innovation Act of 2009 and continues to 
be marketed pursuant to such licensure.
``(c) Out-of-Network Providers.--Nothing in this section requires a 
plan or issuer that has a network of providers to provide benefits for 
selected insulin products described in this section that are delivered 
by an out-of-network provider, or precludes a plan or issuer that has a 
network of providers from imposing higher cost-sharing than the levels 
specified in subsection (a) for selected insulin products described in 
this section that are delivered by an out-of-network provider.
``(d) Rule of Construction.--Subsection (a) shall not be construed 
to require coverage of, or prevent a group health plan or health 
insurance coverage from imposing cost-sharing other than the levels 
specified in subsection (a) on, insulin products that are not selected 
insulin products, to the extent that such coverage is not otherwise 
required and such cost-sharing is otherwise permitted under Federal and 
applicable State law.
``(e) Application of Cost-Sharing Towards Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection 
(a)(2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan or coverage.''.
(b) IRC.--
(1) In general.--Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986 is amended by adding at the end 
the following new section:

``SEC. 9826. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN 
INSULIN PRODUCTS.

``(a) In General.--For plan years beginning on or after January 1, 
2026, a group health plan shall provide coverage of selected insulin 
products, and with respect to such products, shall not--
``(1) apply any deductible; or
``(2) impose any cost-sharing in excess of the lesser of, 
per 30-day supply--
``(A) $35; or
``(B) the amount equal to 25 percent of the 
negotiated price of the selected insulin product net of 
all price concessions received by or on behalf of the 
plan, including price concessions received by or on 
behalf of third-party entities providing services to 
the plan, such as pharmacy benefit management services.
``(b) Definitions.--In this section:
``(1) Selected insulin products.--The term `selected 
insulin products' means at least one of each dosage form (such 
as vial, pump, or inhaler dosage forms) of each different type 
(such as rapid-acting, short-acting, intermediate-acting, long-
acting, ultra long-acting, and premixed) of insulin (as defined 
below), when available, as selected by the group health plan.
``(2) Insulin defined.--The term `insulin' means insulin 
that is licensed under subsection (a) or (k) of section 351 of 
the Public Health Service Act (42 U.S.C. 262) and continues to 
be marketed under such section, including any insulin product 
that has been deemed to be licensed under section 351(a) of 
such Act pursuant to section 7002(e)(4) of the Biologics Price 
Competition and Innovation Act of 2009 (Public Law 111-148) and 
continues to be marketed pursuant to such licensure.
``(c) Out-of-Network Providers.--Nothing in this section requires a 
plan that has a network of providers to provide benefits for selected 
insulin products described in this section that are delivered by an 
out-of-network provider, or precludes a plan that has a network of 
providers from imposing higher cost-sharing than the levels specified 
in subsection (a) for selected insulin products described in this 
section that are delivered by an out-of-network provider.
``(d) Rule of Construction.--Subsection (a) shall not be construed 
to require coverage of, or prevent a group health plan from imposing 
cost-sharing other than the levels specified in subsection (a) on, 
insulin products that are not selected insulin products, to the extent 
that such coverage is not otherwise required and such cost-sharing is 
otherwise permitted under Federal and applicable State law.
``(e) Application of Cost-Sharing Towards Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection 
(a)(2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan.''.
(2) Clerical amendment.--The table of sections for 
subchapter B of chapter 100 of the Internal Revenue Code of 
1986 is amended by adding at the end the following new item:

``Sec. 9826. Requirements with respect to cost-sharing for certain 
insulin products.''.
(c) ERISA.--
(1) In general.--Subpart B of part 7 of subtitle B of title 
I of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1185 et seq.) is amended by adding at the end the 
following:

``SEC. 726. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN 
INSULIN PRODUCTS.

``(a) In General.--For plan years beginning on or after January 1, 
2026, a group health plan or health insurance issuer offering group 
health insurance coverage shall provide coverage of selected insulin 
products, and with respect to such products, shall not--
``(1) apply any deductible; or
``(2) impose any cost-sharing in excess of the lesser of, 
per 30-day supply--
``(A) $35; or
``(B) the amount equal to 25 percent of the 
negotiated price of the selected insulin product net of 
all price concessions received by or on behalf of the 
plan or coverage, including price concessions received 
by or on behalf of third-party entities providing 
services to the plan or coverage, such as pharmacy 
benefit management services.
``(b) Definitions.--In this section:
``(1) Selected insulin products.--The term `selected 
insulin products' means at least one of each dosage form (such 
as vial, pump, or inhaler dosage forms) of each different type 
(such as rapid-acting, short-acting, intermediate-acting, long-
acting, ultra long-acting, and premixed) of insulin (as defined 
below), when available, as selected by the group health plan or 
health insurance issuer.
``(2) Insulin defined.--The term `insulin' means insulin 
that is licensed under subsection (a) or (k) of section 351 of 
the Public Health Service Act (42 U.S.C. 262) and continues to 
be marketed under such section, including any insulin product 
that has been deemed to be licensed under section 351(a) of 
such Act pursuant to section 7002(e)(4) of the Biologics Price 
Competition and Innovation Act of 2009 (Public Law 111-148) and 
continues to be marketed pursuant to such licensure.
``(c) Out-of-Network Providers.--Nothing in this section requires a 
plan or issuer that has a network of providers to provide benefits for 
selected insulin products described in this section that are delivered 
by an out-of-network provider, or precludes a plan or issuer that has a 
network of providers from imposing higher cost-sharing than the levels 
specified in subsection (a) for selected insulin products described in 
this section that are delivered by an out-of-network provider.
``(d) Rule of Construction.--Subsection (a) shall not be construed 
to require coverage of, or prevent a group health plan or health 
insurance coverage from imposing cost-sharing other than the levels 
specified in subsection (a) on, insulin products that are not selected 
insulin products, to the extent that such coverage is not otherwise 
required and such cost-sharing is otherwise permitted under Federal and 
applicable State law.
``(e) Application of Cost-Sharing Towards Deductibles and Out-of-
Pocket Maximums.--Any cost-sharing payments made pursuant to subsection 
(a)(2) shall be counted toward any deductible or out-of-pocket maximum 
that applies under the plan or coverage.''.
(2) Clerical amendment.--The table of contents in section 1 
of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1001 et seq.) is amended by inserting after the item 
relating to section 725 the following:

``Sec. 726. Requirements with respect to cost-sharing for certain 
insulin products.''.
(d) No Effect on Other Cost-Sharing.--Section 1302(d)(2) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 18022(d)(2)) is 
amended by adding at the end the following new subparagraph:
``(D) Special rule relating to insulin coverage.--
The exemption of coverage of selected insulin products 
(as defined in section 2799A-11(b) of the Public Health 
Service Act) from the application of any deductible 
pursuant to section 2799A-11(a)(1) of such Act, section 
726(a)(1) of the Employee Retirement Income Security 
Act of 1974, or section 9826(a)(1) of the Internal 
Revenue Code of 1986 shall not be considered when 
determining the actuarial value of a qualified health 
plan under this subsection.''.
(e) Coverage of Certain Insulin Products Under Catastrophic 
Plans.--Section 1302(e) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18022(e)) is amended by adding at the end the following:
``(4) Coverage of certain insulin products.--
``(A) In general.--Notwithstanding paragraph 
(1)(B)(i), a health plan described in paragraph (1) 
shall provide coverage of selected insulin products, in 
accordance with section 2799A-11 of the Public Health 
Service Act, for a plan year before an enrolled 
individual has incurred cost-sharing expenses in an 
amount equal to the annual limitation in effect under 
subsection (c)(1) for the plan year.
``(B) Terminology.--For purposes of subparagraph 
(A)--
``(i) the term `selected insulin products' 
has the meaning given such term in section 
2799A-11(b) of the Public Health Service Act; 
and
``(ii) the requirements of section 2799A-11 
of such Act shall be applied by deeming each 
reference in such section to `individual health 
insurance coverage' to be a reference to a plan 
described in paragraph (1).''.
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