H.R. 2636: Making Insulin Affordable for All Children Act

This bill, titled the Making Insulin Affordable for All Children Act, aims to ensure that individuals who are 26 years of age or younger receive affordable insulin products under their health insurance plans. Here’s a breakdown of what the bill proposes:

Key Provisions

• Coverage for Insulin Products: Starting from January 1, 2026, health insurance plans must cover selected insulin products for young individuals without imposing any deductible. This means that covered individuals would not have to pay an initial amount before insurance kicks in for insulin products.
• Cost-Sharing Limits: For each 30-day supply of insulin, the maximum cost that a covered individual would need to pay is limited to either $35 or 25% of the negotiated price of the insulin, whichever is lower. This is intended to reduce the financial burden on individuals who rely on insulin to manage their diabetes.
• Defined Terms: The term “selected insulin products” is defined to include at least one dosage form of each type of insulin (like rapid-acting, long-acting, etc.) as decided by the health plan. Furthermore, the bill defines insulin in accordance with existing U.S. health laws.
• Impact on Deductibles and Out-of-Pocket Maximums: Any payments made towards the cost-sharing for insulin will count towards the overall deductible and out-of-pocket maximums that apply under the plan. This is aimed at helping individuals reach their coverage limits more efficiently.

No Requirement for Non-Covered Products:

The bill makes it clear that it does not require insurance plans to cover insulin products that are not considered selected insulin products. Plans may impose different cost-sharing arrangements for these non-covered items, provided such arrangements are allowed under federal and state laws.

Implementation Authority:

The Secretary of Health and Human Services, along with the Secretaries of Labor and Treasury, will have the authority to implement these provisions, including issuing guidance for compliance.

Amendments to Existing Laws:

This bill amends various sections of existing U.S. laws, including the Public Health Service Act and the Employee Retirement Income Security Act (ERISA), to incorporate these new requirements related to insulin coverage.

Relevant Companies

• NVO (Novo Nordisk): As a major manufacturer of insulin products, this company may experience changes in product pricing strategies or insurance partnerships due to the new cost-sharing requirements. This could potentially impact their sales and market approach in the U.S. for insulin products.
• SNY (Sanofi): Another key player in the insulin market, Sanofi may need to adjust the pricing and accessibility of their insulin products in response to mandatory coverage limits outlined in the bill.
• LLY (Eli Lilly): Eli Lilly, known for its insulin medications, could also be affected by these regulations as it may impact their pricing and market strategy in light of new cost-sharing limitations.