Senators in Washington unveiled a bipartisan plan this week that would cap out-of-pocket insulin costs at $35 a month for people covered by private and employer-sponsored insurance. The proposal ties long-running insulin affordability efforts to new language on rebate reform and a limited pathway for uninsured patients. Sponsors say the measure would extend the relief seniors received under the Inflation Reduction Act and make a similar $35 cap available to millions with commercial coverage, as per the Congress.gov.
What the INSULIN Act Would Do
Formally titled the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, the bill would require group and individual market health plans to waive deductibles and limit cost-sharing to $35 or 25% of the negotiated price for at least one insulin product of each type and dosage form, according to a Shaheen press release. The text also seeks to require pharmacy benefit managers to pass 100% of insulin rebates to plan sponsors, a change supporters say would move savings toward patients and employers. Earlier versions of the INSULIN Act are available on Congress.gov. Sponsors say the measure is written so that plans must cover at least one vial, pen or pump-compatible formulation at the capped price.
How The Uninsured Could Be Covered
Because a universal $35 cap for uninsured people would carry a hefty price tag, the bill opts for a compromise. It creates a pilot program that would let up to 10 states provide capped insulin to uninsured residents through federally qualified health centers, participating retail pharmacies and manufacturer assistance programs, with the Department of Health and Human Services choosing states based on need. A health policy roundup at Alston & Bird described the pilot and related provisions, including an insulin resource center and hotline for patients without coverage. Backers say that targeted pilot is the tradeoff that persuaded more senators to support the package while still giving uninsured people some route to affordable insulin.
Who’s Backing It
Major diabetes organizations quickly lined up behind the effort, calling the INSULIN Act a meaningful step to cut back on dangerous insulin rationing and financial strain for people with diabetes. The American Diabetes Association and patient advocacy group Breakthrough T1D both issued statements praising the bipartisan text and urging Congress to move quickly. Industry groups and fiscal watchdogs, however, have warned lawmakers that the rebate reforms and the uninsured pilot will need clear budget offsets and careful implementation to avoid unintended fallout.
Political Hurdles Ahead
Supporters are hoping to hitch the INSULIN Act to must-pass legislation later this year, but the plan still needs buy-in from Senate leaders and the White House to secure floor time and votes. Semafor reports that sponsors are still negotiating how to pay for the package and how exactly the rebate pass-throughs for pharmacy benefit managers would work. Policy shops have already flagged implementation questions that could slow the march to passage, and legal and budget advisers are expected to scrutinize the PBM language to see how any savings are counted and where the costs ultimately land.
What’s Next
The bill was formally filed this week, and sponsors say they will focus on building a large list of co-sponsors and briefing Senate leadership in the coming days. “Insulin is a 100‑year‑old drug with a patent that was sold for $1. No one should feel forced to put their health or life in danger because they can’t afford their insulin,” Sen. Raphael Warnock said in a release. Shaheen’s office and Warnock’s office provided statements outlining the plan and the next steps.
