Capping Insulin Costs: Maximum $35 Monthly Copay for Insured Patients starting 2026.
This law establishes a maximum cost-sharing limit for selected insulin products covered by group and individual health plans. Starting in 2026, insured individuals will pay no more than $35 per 30-day supply, and health plans cannot apply deductibles to these specific medications. This change aims to significantly reduce the monthly financial burden of diabetes management for millions of Americans.
Key points
The maximum cost for a 30-day supply of selected insulin will be capped at $35 or 25% of the negotiated price, whichever is lower.
Health plans are prohibited from requiring patients to meet their deductible before covering the cost of selected insulin products.
All cost-sharing payments made for insulin must count toward the patient's annual out-of-pocket maximum.
The rules apply to plan years beginning on or after January 1, 2026.
Status:
Introduced
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