HR 10227: INSULIN Act of 2026

HR 10227 in plain English: The INSULIN Act of 2026 would cap out-of-pocket costs for insulin at $35 per month for people with health insurance, with the cap dropping further starting in 2028 to the lesser of $35 or 25 percent of the negotiated price. The bill also authorizes $2,000,000 per year from 2027 through 2032 to carry out its provisions.

Stated purpose

The bill aims to reduce the price of insulin for patients and establish protections limiting how much people with insurance must pay out of pocket for insulin products.

Key points

• Caps insured patients' monthly insulin costs at $35 for plan years before January 1, 2028
• Starting January 1, 2028, caps monthly insulin costs at the lesser of $35 or 25% of the negotiated price
• Authorizes $2,000,000 per year for fiscal years 2027 through 2032 to implement the law
• Includes provisions related to expediting biosimilar insulin products

Arguments supporters make

• Insulin is a life-sustaining medication, and capping costs at $35 per month ensures no diabetic patient has to ration or skip doses because of unaffordable prices.
• The bill covers multiple insulin types and delivery forms, so patients are not locked into a single product and can get the specific insulin their doctor recommends without extra cost barriers.
• Requiring that all price concessions from manufacturers and middlemen be factored into the patient's cost calculation closes loopholes that can keep list prices high while savings go to insurers rather than patients.

Arguments opponents make

• Forcing insurers to absorb capped insulin costs without a corresponding reduction in manufacturers' prices may cause insurers to raise premiums or cost-share more on other drugs, shifting costs onto all policyholders.
• The bill applies only to people with private insurance, leaving uninsured patients and those in coverage gaps without the same protections, so the hardest-to-reach populations may see little benefit.
• Limiting prior authorization and medical management tools for insulin could reduce insurers' ability to encourage lower-cost biosimilar insulins, potentially undermining long-term price competition in the market.

Tradeoffs

Capping insulin costs directly benefits insured diabetes patients but may spread those costs across all policyholders through higher premiums; the bill also prioritizes immediate out-of-pocket relief for the insured over broader measures that might lower insulin list prices for everyone, including the uninsured.

Current status in Congress: In committee.

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