Making Insulin Affordable for All Children Act
Summary
What This Bill Does
The Making Insulin Affordable for All Children Act creates parallel insulin cost-sharing rules across the Public Health Service Act, ERISA, and the Internal Revenue Code. For plan years starting January 1, 2026, group health plans and health insurance issuers must cover selected insulin products for enrollees age 26 or younger without applying a deductible and without charging more than the lesser of $35 per 30-day supply or 25 percent of the product's negotiated price net of rebates and other concessions. Plans must count those payments toward deductibles and out-of-pocket maximums, and high-deductible health plans must provide the insulin coverage before the enrollee reaches the annual deductible limit.
Who Benefits and How
Children and young adults with diabetes benefit because covered insulin becomes available before deductibles and with a hard monthly cost-sharing cap. Families paying for pediatric or young-adult insulin benefit from lower and more predictable pharmacy costs. Employer plan participants benefit because ERISA plans must apply the same selected-insulin protection as individual-market coverage. Health care affordability advocates benefit because the bill exposes rebate and pharmacy benefit manager concessions in the cost-sharing cap formula.
Who Bears the Burden and How
Group health plans must cover selected insulin dosage forms and types before deductibles and track the $35 or 25 percent cap. Health insurance issuers must update benefit designs, pharmacy claims systems, and actuarial filings for 2026 plan years. Pharmacy benefit managers face reduced ability to let rebate structures translate into high insulin cost sharing for young enrollees. Employers sponsoring health plans may absorb premium or plan-cost effects from the capped insulin cost sharing.
Key Provisions
- Requires selected insulin coverage for enrollees age 26 or younger beginning with 2026 plan years.
- Bars deductibles and caps cost sharing at the lesser of $35 per 30-day supply or 25 percent of net negotiated price.
- Requires cost-sharing payments to count toward deductibles and out-of-pocket maximums.
- Extends the insulin protection across private insurance, ERISA group plans, tax-qualified group plans, and high-deductible health plans.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Caps cost sharing for selected insulin products at no deductible and no more than the lesser of $35 or 25 percent of net negotiated price for insured children and young adults age 26 or younger beginning in 2026.
Key Policy Areas
Health Care, Insurance, Prescription Drugs
Primary Purpose
Caps cost sharing for selected insulin products at no deductible and no more than the lesser of $35 or 25 percent of net negotiated price for insured children and young adults age 26 or younger beginning in 2026.
Policy Domains
Resolution provisions
Identified Gains
- Children with diabetes
- Young adults with diabetes
- Families paying for insulin
- Health care affordability advocates
Identified Costs
- Group health plans
- Health insurance issuers
- Pharmacy benefit managers
- Employer plan sponsors
Sponsors
Legislative Progress
In CommitteeMr. Landsman (for himself, Ms. Norton, Ms. Dean of Pennsylvania, …
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Children with diabetes, Families paying for insulin, Young adults with diabetes
Group health plans, Health insurance issuers
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology