H.R. 2636: Making Insulin Affordable for All Children Act

H.R. 2636 would require many private health plans to cover certain insulin products for people 26 and under with no deductible and no more than $35 in cost-sharing for a 30-day supply.

The cap is actually the lower of two numbers: $35 or 25% of the negotiated price after rebates and other price concessions. That means if a plan's net price is lower, your out-of-pocket cost could be lower too.

The bill does not force plans to cover every insulin product on the market. Instead, they would have to cover at least one product in each major insulin type and dosage form when available — including categories like rapid-acting and long-acting insulin, and forms like vials, pumps, or inhalers.

This is not a universal insulin cap: the guaranteed limit applies to selected insulin products and only to people age 26 or younger. Older patients could still face standard cost-sharing unless other law says otherwise.

The bill also says whatever you do pay for covered insulin still counts toward your deductible and out-of-pocket maximum. So families would get the lower upfront price without losing credit toward the rest of their annual health costs.

H.R. 2636 also applies the rule to catastrophic plans, which often require high upfront spending before coverage kicks in. Under this bill, those plans would still have to cover selected insulin for eligible enrollees before that larger spending threshold is met.