Affordable Insulin Now Act
Summary
The Affordable Insulin Now Act aims to lower the cost of insulin for many Americans by amending the Public Health Service Act, the Internal Revenue Code, and the Employee Retirement Income Security Act. It mandates that group health plans and health insurance issuers provide coverage for selected insulin products with limited cost-sharing. This includes capping the cost at either $35 per 30-day supply or 25% of the negotiated price, whichever is lower, starting in 2026.
The bill defines 'selected insulin products' as at least one of each dosage form and type of insulin. It also clarifies that these cost-sharing limits do not apply to out-of-network providers or non-selected insulin products, and that cost-sharing payments count towards deductibles and out-of-pocket maximums.
Furthermore, the act amends the Patient Protection and Affordable Care Act to ensure that the cost-sharing limitations are considered when determining the actuarial value of a qualified health plan and to provide coverage for selected insulin products under catastrophic plans before enrollees meet their annual cost-sharing limits.
Expected Effects
This act will likely reduce the out-of-pocket expenses for individuals with diabetes who rely on insulin. It standardizes cost-sharing for insulin across various health plans.
However, it may also lead to adjustments in insurance premiums or cost-shifting to other healthcare services. The specific impact on premiums and overall healthcare costs will depend on how insurance companies and pharmacy benefit managers respond to the new regulations.
Additionally, the act's focus on 'selected insulin products' could create complexities in coverage and access for individuals requiring specific insulin formulations not included in the 'selected' category.
Potential Benefits
- Reduced out-of-pocket costs for insulin for many insured individuals.
- Increased predictability in insulin expenses, aiding in budgeting and financial planning for individuals with diabetes.
- Improved access to insulin, potentially leading to better health outcomes and reduced risk of complications from diabetes.
- Standardized cost-sharing rules across different types of health plans.
- Coverage of insulin products under catastrophic plans before deductibles are met.
Potential Disadvantages
- Potential for increased health insurance premiums to offset the reduced cost-sharing for insulin.
- Limited scope, as the cost-sharing caps only apply to 'selected insulin products,' potentially excluding some insulin formulations.
- Possible cost-shifting to other healthcare services or prescription drugs.
- Increased administrative complexity for health plans and insurers in managing and defining 'selected insulin products.'
- The act does not address the underlying high prices of insulin, potentially leading to continued reliance on government intervention.
Constitutional Alignment
The Affordable Insulin Now Act appears to align with the general welfare clause of the US Constitution (Preamble). Congress is authorized to "promote the general Welfare".
By addressing healthcare costs and access, the act can be argued to fall under Congress's power to regulate interstate commerce (Article I, Section 8), as health insurance and pharmaceutical industries operate across state lines. The Act amends existing laws related to healthcare and employee benefits, which have already been established under congressional authority.
However, some may argue that the Act's mandates on health insurance plans could infringe upon individual liberty or states' rights, although these arguments would likely be balanced against the government's interest in promoting public health and welfare.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).