A bipartisan group of four senators introduced legislation Wednesday that would impose a $35 monthly cap on out-of-pocket insulin costs for Americans with private health insurance. The bill, titled the Improving Needed Safeguards for Users of Lifesaving Insulin Now (INSULIN) Act, represents a rare cross-aisle agreement on healthcare affordability as election-year pressures mount.
The legislation is sponsored by Senators Jeanne Shaheen (D-N.H.), Susan Collins (R-Maine), Raphael Warnock (D-Ga.), and John Kennedy (R-La.). If enacted, the cap would take effect at the start of 2027. The measure would waive deductibles for insulin and limit patient cost-sharing to either $35 per month or 25 percent of the drug's list price, whichever is lower.
Addressing a Critical Need
In a statement, Senator Shaheen framed the issue as a matter of basic necessity. "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," she said. The proposal arrives amid broader concerns about healthcare expenses, as illustrated by a recent poll showing ACA enrollees sacrificing essentials due to spiking costs.
Senator Kennedy emphasized the systemic fix the bill aims to provide. "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," he said.
Key Provisions and Pilot Program
Beyond the cost cap, the legislation includes significant reforms targeting pharmacy benefit managers (PBMs). It would mandate that PBMs pass through 100 percent of rebates and other financial benefits received from insulin manufacturers to the insurance plan sponsors, a move intended to increase transparency and direct savings to patients.
A critical component, championed by Senator Warnock, addresses the uninsured. The bill establishes a 10-state pilot program designed to identify uninsured individuals with diabetes and provide them access to insulin for $35 per month through federal funding awarded to community health centers. A spokesperson for Warnock noted the senator was "instrumental in ensuring uninsured Americans were not left out," particularly relevant for states like Georgia that have not expanded Medicaid.
The bill also contains network provisions, stating that insurance plans with their own provider networks would not be required to cover insulin delivered by out-of-network providers. The Government Accountability Office would be tasked with evaluating the program's effectiveness and publishing a report.
Building on Existing Efforts
This congressional effort builds on recent actions to lower insulin costs. The Inflation Reduction Act previously instituted a $35 monthly cap for Medicare Part D and Part B enrollees. Concurrently, voluntary price reductions by major insulin manufacturers have contributed to a decline in the drug's average price. According to data from GoodRx, the price per unit fell from 33 cents in 2019 to 19 cents in 2024.
Furthermore, several states—including California, Connecticut, Kentucky, Maryland, and Minnesota—have already enacted their own insulin price caps, typically limiting a 30-day supply to $35 or less for state-regulated health plans. The federal legislation would create a nationwide baseline for the privately insured population.
The bill's fate in a divided Congress remains uncertain, as it joins a queue of other bipartisan initiatives facing legislative hurdles, such as the delayed FISA reauthorization and the stalled Department of Homeland Security funding deal. Its progress will test whether consensus on drug pricing can translate into law.
