Senate deal reached to cap insulin costs

Sens. Jeanne Shaheen (D-N.H.), Susan Collins (R-Maine), Raphael Warnock (D-Ga.) and John Kennedy (R-La.) introduced the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, which would limit out-of-pocket costs for people with diabetes by waiving any deductibles and limiting cost sharing to $35 or 25 percent of the list price per month.

If signed, the bill would go into effect at the beginning of 2027.

“The cost of insulin is getting more expensive year after year, forcing one in five Americans with diabetes to ration their insulin. That is completely unacceptable, and it’s particularly galling at a time when costs for Americans—including health care prices—are going up across the board,” Shaheen said in a statement.

“Our bipartisan INSULIN Act would save Americans money, help them avoid life-threatening diabetes complications, and make our health care system look a bit more like we designed it on purpose,” Kennedy said.

The bill would also require pharmacy benefit managers to pass through 100 percent of insulin rebates and other benefits they receive from manufacturers to insurance plan sponsors. It would also establish pilot programs in 10 states aimed at identifying uninsured people with diabetes and providing them with $35 monthly insulin.

Insurance plans with their own network of providers would not be required to provide benefits for insulin products that are delivered by out-of-network providers.

The Government Accountability Office will also be tasked with publishing a report evaluating the success of the program.

A spokesperson for Warnock said the Georgia senator was “instrumental in ensuring uninsured Americans were not left out of the bipartisan legislation,” as one of a few Democrats representing states where Medicaid has not been expanded.

“It was his leadership that ultimately led to language that will establish a new 10-state pilot program, awarding federal funding to community health centers (CHCs) to help provide affordable insulin to uninsured patients,” said the spokesperson.

The Inflation Reduction Act similarly included a $35 cap on insulin for Medicare Part D enrollees, which was later expanded to include Part B enrollees. These moves, along with voluntary price cuts by insulin manufacturers, have been credited with lowering the cost of the drug in recent years, with GoodRx noting last year that the price per unit had fallen from 33 cents in 2019 to 19 cents in 2024.

Many states also have their own insulin price caps. California, Connecticut, Kentucky, Maryland and Minnesota all have price caps limiting a 30-day supply of insulin to $35 or less. These mandates apply to state-regulated health plans in some cases.