Affordable Insulin Act: $35 Cost Cap for Insured and Aid for Uninsured.
This bill aims to significantly lower insulin costs for individuals with private health insurance by capping patient cost-sharing at a maximum of $35 per 30-day supply. Furthermore, it establishes a program to ensure uninsured individuals can also access insulin products for no more than $35 per 30-day supply, with the government reimbursing providers for the difference. These changes are scheduled to take effect starting January 1, 2024, directly impacting the finances and healthcare access of millions of citizens with diabetes.
Key points
Insulin Cost Cap: Private health plans cannot impose cost-sharing exceeding the lesser of $35 or 25% of the negotiated price for a 30-day supply of selected insulin products.
No Deductibles: Health plans are prohibited from applying any deductible to the selected insulin products covered under the cost-sharing limit.
Aid for Uninsured: A new program will be created to reimburse healthcare providers and pharmacies for furnishing insulin to uninsured individuals, ensuring their out-of-pocket cost is capped at $35.
Cost-Sharing Counts: Any cost-sharing payments made for insulin under this cap must be counted toward the individual's annual deductible and out-of-pocket maximums.
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