H.R. 6255: Affordable Insulin Now Act

This bill, known as the Affordable Insulin Now Act, aims to reduce the out-of-pocket costs for insulin products for individuals enrolled in group health plans or health insurance coverage. It establishes specific requirements for these plans regarding insulin coverage, specifically targeting coverage for certain selected insulin products.

Key Provisions of the Bill

• Cost-sharing Requirements: Starting from January 1, 2026, group health plans and health insurance issuers will be required to cover selected insulin products without imposing any deductible. Furthermore, cost-sharing for these products cannot exceed $35 for a 30-day supply, or 25% of the negotiated price of the product, whichever is lower.
• Definition of Selected Insulin Products: "Selected insulin products" refers to at least one dosage form (like vial, pump, or inhaler) of each type (such as rapid-acting or long-acting) of insulin that is available and chosen by the health plan or insurer.
• Insulin Definition: The bill defines insulin as products licensed under specific health service regulations and includes those products that continue to be marketed under these licenses.
• Out-of-Network Providers: The bill does not require plans or issuers to cover insulin products obtained from out-of-network providers. Plans may impose higher costs for these products if they are not provided by in-network providers.
• Application to Deductibles and Out-of-Pocket Maximums: Any payments made towards insulin cost-sharing will count toward the deductibles and out-of-pocket limits of the health plan.
• Other Coverage Provisions: The bill clarifies that it does not mandate coverage for non-selected insulin products and outlines how coverage for insulin products interacts with other health care regulations.

Impact on Existing Health Plans

The legislation would not alter the overall structure of health plans but would require specific adherence to the stipulated insulin coverage requirements. Plans will need to adjust their coverage policies and pricing structures accordingly, to comply with the new regulations.

Relevant Companies

• NVS (Novartis AG): Novartis produces insulin products and may be directly impacted by changes in cost-sharing regulations and requirements for coverage.
• LLY (Eli Lilly and Company): Eli Lilly is a major supplier of insulin and would be affected by the rules regarding pricing and availability in health plans.
• CM (Canadian Imperial Bank of Commerce): While not directly linked to insulin production, changes in health insurance coverage particularly around insulin could influence financial services associated with healthcare financing.