Insulin Cost-Sharing Capped at $35 for Most Insured Patients Starting in 2026

The Affordable Insulin Now Act is about to change the math for millions of Americans who rely on insulin. Starting with plan years on or after January 1, 2026, this legislation mandates a hard cap on what most insured patients pay out-of-pocket for a 30-day supply of certain insulin products. That cap is the lesser of $35 or 25% of the health plan’s negotiated price, which means a big chunk of financial predictability for managing diabetes.

The New Bottom Line for Insulin Users

For anyone currently staring down a $100 or $200 copay for their monthly insulin supply, this bill is a game-changer. It applies to nearly all group health plans and individual health insurance policies, including those governed by ERISA, the Public Health Service Act, and the Internal Revenue Code (Section 2). Crucially, these cost-sharing payments must count toward your annual deductible and out-of-pocket maximum, which is a significant win. If you’re on a high-deductible plan, especially a “catastrophic” plan, this means you can get your necessary insulin for $35 without having to hit your massive deductible first (Sec. 2).

The Fine Print: What is “Selected Insulin”?

Now, here’s where the policy gets a little tricky. The $35 cap doesn't apply to every insulin product on the market. It only applies to a plan’s “selected insulin product” (Sec. 2). The bill defines this as at least one of each dosage form (like a vial or pen) of each different type of insulin (like rapid-acting or long-acting) available. The key detail is that the health plan or insurer gets to choose which specific brand within each category qualifies for the cap. This means if you rely on a specific, non-selected brand of insulin for medical reasons, you might still face the plan’s standard, higher cost-sharing for that particular medication. The goal is certainty, but the plan determines the specific product.

Where the Cap Doesn’t Apply

While the cap is strong, it has two major limits that could catch busy people off guard. First, the plan is not required to apply the $35 limit if you get your insulin from an out-of-network pharmacy (Sec. 2). For people in rural areas or those using mail-order pharmacies that might not be in-network, this could mean paying significantly more. Second, if you need a type of insulin that your plan didn't select for the cap—say, a specific long-acting brand—you’ll still be subject to the plan’s regular cost-sharing rules for that product. For the millions of folks juggling work, family, and medical needs, this means you’ll need to double-check your plan’s formulary when 2026 rolls around to ensure your specific prescription is covered under the new cap.