HR-6255-119
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Angie Craig (D-MN)
What it does
The Affordable Insulin Now Act would cap out-of-pocket costs for insulin for patients covered by private health insurance and, likely, Medicare Part D. Based on prior versions of this bill introduced in earlier Congresses, it would limit monthly insulin copayments to $35. The bill is currently in committee and its precise provisions have not been published in full text.
Who benefits
The approximately 7-8 million Americans who use insulin and carry insurance coverage, particularly those currently paying above the cap. Medicare Part D enrollees on fixed incomes who face high monthly insulin costs. Patients with Type 1 diabetes, who have no alternative to insulin. Patients with Type 2 diabetes who require insulin therapy. Hospitals and emergency departments that treat patients who have rationed insulin and experienced complications. Employers and insurers who may see reduced costs from fewer diabetes-related hospitalizations over time.
Who is hurt
Insulin manufacturers (Eli Lilly, Novo Nordisk, Sanofi), who would face indirect pricing pressure and reduced revenue above the cap threshold. Pharmacy benefit managers (PBMs), who would lose negotiating leverage and rebate revenue tied to higher list prices. Insurers, who may absorb costs above the cap or spread them across premiums for all policyholders. Uninsured patients, who would not benefit from the cap and could see the coverage gap widen relative to insured peers. Taxpayers, who may bear costs if the cap increases federal spending through Medicare or ACA marketplace subsidies.
Supporters argue
Supporters argue that insulin list prices in the U.S. are roughly 10 times higher than in comparable countries, and that CDC survey data shows one in four insulin-dependent patients rations doses due to cost — a practice linked to hospitalizations and preventable deaths. They contend that the $35 cap, already enacted for Medicare Part D under the Inflation Reduction Act of 2022, proved workable without disrupting supply, and that extending it to private insurance closes an inequity that leaves millions of working-age Americans without the same protection afforded to seniors.
Opponents argue
Opponents argue that price caps treat a symptom rather than the underlying cause — opaque rebate arrangements between manufacturers and PBMs — and that capping copays without addressing list prices may shift costs onto broader insurance premiums, raising expenses for all policyholders. They contend that government-mandated pricing limits could reduce manufacturers' incentives to develop next-generation insulin formulations, and that the proper mechanism for lowering drug costs is increased market competition and transparency, not federal price controls on a specific product.