S. 4189: INSULIN Act of 2026

The INSULIN Act of 2026 aims to make insulin more affordable and accessible for Americans. Starting in 2027, it requires private health insurance plans to cap the cost of a 30-day supply of insulin at $35, without applying deductibles. From 2028, this cap will be the lesser of $35 or 25% of the negotiated price, potentially lowering costs further. The bill also mandates that Pharmacy Benefit Managers (PBMs) pass 100% of insulin-related rebates and discounts directly to health plans, increasing transparency. Additionally, it establishes a five-year pilot program in 10 states to provide uninsured individuals with insulin at no more than $35 per month through community clinics and pharmacies. To support the uninsured, a national resource center and 24/7 hotline will be created to help them find affordable insulin options. The bill also seeks to expedite the approval of biosimilar insulin products to foster competition and reduce prices.

Media outlets have largely praised the INSULIN Act of 2026 for its bipartisan support and comprehensive approach to reducing insulin costs. The bill's provisions to cap monthly insulin expenses for insured individuals and to assist the uninsured have been highlighted as significant steps toward addressing the financial burden faced by people with diabetes. The requirement for PBMs to pass through all rebates and discounts is seen as a move toward greater transparency in drug pricing. Additionally, the pilot program for uninsured individuals and the establishment of a national resource center are viewed as proactive measures to ensure broader access to affordable insulin. The expedited approval process for biosimilar insulin products is also commended for its potential to increase competition and drive down prices.

Critics have raised concerns that while the INSULIN Act of 2026 addresses out-of-pocket costs, it does not tackle the underlying high list prices set by manufacturers. There is apprehension that capping costs for insured individuals might lead to higher insurance premiums as insurers seek to offset the reduced cost-sharing. Some analysts argue that the bill's focus on PBMs may not fully address the complexities of the pharmaceutical supply chain that contribute to high insulin prices. Additionally, the pilot program for uninsured individuals is limited to 10 states, which may leave many without access to affordable insulin. The effectiveness of the expedited approval process for biosimilar insulin products is also questioned, as it remains to be seen how quickly and effectively it will lead to increased competition and lower prices.

The analysis of Bill S. 4189, the INSULIN Act of 2026, sponsored by Jeanne Shaheen, reveals no direct industry overlaps between the bill's subject matter and the sponsor's top donor industries. The lobbying activity associated with this bill includes several organizations, but none appear to have a direct financial interest in insulin pricing or pharmaceutical regulations. The largest contributions come from SAILDRONE INC., which has provided over $787,000 in total, but this company operates in the environmental technology sector, unrelated to healthcare or insulin. Therefore, the risk of conflicts of interest is considered low as there are no evident financial incentives that could influence the legislative outcome regarding insulin pricing.

Organizations that lobbied on issues related to this bill's policy area.

Source: Senate Lobbying Disclosure Act (LDA) filings, 2026