S. 4512

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4512 Introduced in Senate (IS)]

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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 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 of 
2026''.

SEC. 2. APPROPRIATE COST-SHARING FOR INSULIN PRODUCTS COVERED UNDER 
PRIVATE HEALTH PLANS.

(a) In General.--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:

``SEC. 2799A-12. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN 
INSULIN PRODUCTS.

``(a) In General.--For plan years beginning on or after January 1, 
2027, 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, 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.
``(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) 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-12(b) of the Public Health 
Service Act) from the application of any deductible 
pursuant to section 2799A-12(a)(1) of such Act, section 
727(a)(1) of the Employee Retirement Income Security 
Act of 1974, or section 9827(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.''.
(c) 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-12 of the Public Health 
Service Act, before an enrolled individual has 
incurred, during the plan year, 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-12(b) of the Public Health Service Act; 
and
``(ii) the requirements of section 2799A-12 
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).''.
(d) 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. 727. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN 
INSULIN PRODUCTS.

``(a) In General.--For plan years beginning on or after January 1, 
2027, 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, 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.
``(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 726 the following:

``Sec. 727. Requirements with respect to cost-sharing for certain 
insulin products.''.
(e) Internal Revenue Code.--
(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. 9827. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN 
INSULIN PRODUCTS.

``(a) In General.--For plan years beginning on or after January 1, 
2027, 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, 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.
``(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 such Code is amended by adding 
at the end the following new item:

``Sec. 9827. Requirements with respect to cost-sharing for certain 
insulin products.''.
(f) Implementation.--The Secretary of Health and Human Services, 
the Secretary of Labor, and the Secretary of the Treasury may implement 
the provisions of, including the amendments made by, this subsection 
through sub-regulatory guidance, program instruction or otherwise.

SEC. 3. REIMBURSEMENT FOR INSULIN FURNISHED TO UNINSURED INDIVIDUALS.

(a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a 
program under which the Secretary enters into agreements with 
qualifying entities for purposes of furnishing insulin products to 
uninsured individuals.
(b) Payment.--The Secretary shall pay to each qualifying entity 
with an agreement in effect under this section, with respect to each 
30-day supply of insulin products furnished to an uninsured individual 
by such entity on or after January 1, 2027, an amount equal to the 
difference between the out-of-pocket cost to the individual for a 30-
day supply of such insulin products and $35.
(c) Definitions.--In this section:
(1) Insulin product.--The term ``insulin product'' has the 
meaning given the term ``insulin'' in section 2799A-12 of the 
Public Health Service Act, as added by section 2.
(2) Qualifying entity.--The term ``qualifying entity'' 
means a health care provider or pharmacy that--
(A) agrees, with respect to an insulin product 
furnished by such provider or pharmacy to an uninsured 
individual after January 1, 2027, for which payment is 
made by the Secretary under this section, not to hold 
such individual liable for any payment amount for such 
product; and
(B) meets such other standards and requirements as 
may be determined appropriate by the Secretary.
(3) Specified health plan.--The term ``specified health 
plan'' means a Federal health care program (as defined in 
section 1128B of the Social Security Act (42 U.S.C. 1320a-7b)), 
the health program established under chapter 89 of title 5, 
United States Code, a group health plan (as defined in section 
2791 of the Public Health Service Act (42 U.S.C. 300gg-91)), 
and group or individual health insurance coverage (as defined 
in such section 2791).
(4) Uninsured individual.--The term ``uninsured 
individual'' means, with respect to an individual and an 
insulin product, an individual who does not have benefits 
available for such product (or for another insulin product of 
the same dosage form (such as vial, pump, or inhaler dosage 
forms) and type (such as rapid-acting, short-acting, 
intermediate-acting, long-acting, ultra-long-acting, and 
premixed)) under a specified health plan.

SEC. 4. SENSE OF CONGRESS.

It is the sense of Congress that subsequent legislation should be 
enacted by Congress that provides for an offset for any costs to the 
Federal Government resulting from the enactment of this Act.
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