H.R. 2636: Making Insulin Affordable for All Children Act
Sponsor
Greg Landsman
Democrat · OH-1
Bill Progress
Latest Action · Apr 3, 2025
Referred to 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. for review
Insulin cap targets patients 26 and under
Why it matters
Starting with plan years on or after January 1, 2026, this bill would require many health plans to sharply limit what enrollees age 26 or younger pay for insulin at the pharmacy counter.
H.R. 2636, the Making Insulin Affordable for All Children Act, is a targeted affordability bill aimed at one group: enrolled individuals 26 years of age or younger. For plan years beginning on or after January 1, 2026, group health plans and health insurance issuers offering group or individual coverage would have to cover certain insulin products without any deductible. For each 30-day supply of a covered insulin, the patient’s cost-sharing would be capped at the lesser of $35 or 25 percent of the negotiated price, calculated net of all price concessions, including concessions received by third-party entities such as pharmacy benefit managers.
What Congress Is Saying
H.R. 2636 hasn't been debated on the floor yet.
This section updates when a legislator speaks about it on the floor or in committee.
HR2636 Legislative Journey
House: Committee Action
Apr 3, 2025
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.
About the Sponsor
Greg Landsman
Democrat, Ohio's 1st congressional district · 3 years in Congress
Committees: Energy and Commerce
View full profile →
Cosponsors (8)
All 8 cosponsors are Democrats. Cosponsors represent 7 states: District of Columbia, Kentucky, Minnesota, and 4 more.
Committee Sponsors
Education and Workforce Committee
0 of 36 committee members cosponsored
No committee members have cosponsored this bill
Ways and Means Committee
0 of 45 committee members cosponsored
No committee members have cosponsored this bill
Energy and Commerce Committee
0 of 54 committee members cosponsored
No committee members have cosponsored this bill
59 Democrats across these committees haven't cosponsored yet. Mobilize their constituents
What laws does H.R. 2636 change?
2 changes
Sections Amended
Section 1302(e) of Patient Protection and Affordable Care Act (42 U.S.C. 18022(e))
adding at the end the following: ``(4) Coverage of certain insulin products
Section 1 of Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.)
inserting after the item relating to section 725 the following: ``Sec
H.R. 2636 Quick Facts
- Committee
- Education and Workforce
- Chamber
- House
- Policy
- Health
- Introduced
- Apr 3, 2025
Referred to 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. for review
Apr 3, 2025
H.R. 2636 Common Questions
How much would insulin cost be capped at for people 26 and under under HR 2636?
Under the Making Insulin Affordable for All Children Act, cost-sharing for a 30-day supply of a selected insulin would be capped at the lesser of $35 or 25% of the negotiated price for enrollees age 26 or younger (Section 2).
Can a health plan apply a deductible to insulin for someone age 26 or younger?
No. Under the Making Insulin Affordable for All Children Act, group plans and issuers could not apply any deductible to selected insulin products for enrolled individuals age 26 or younger (Section 2).
When would the insulin cap for children and young adults start under HR 2636?
According to H.R. 2636 Section 2, the rules would apply to plan years beginning on or after January 1, 2026.
Does the insulin cap in HR 2636 apply to individual and employer health plans?
Yes. Under H.R. 2636 Section 2, the requirement applies to group health plans and health insurance issuers offering both group and individual health insurance coverage.
Does HR 2636 require all insulin types to be covered for people 26 and under?
It requires at least one selected insulin product for each dosage form and each insulin type, such as rapid-acting, short-acting, intermediate-acting, long-acting, ultra long-acting, and premixed, under Section 2.
Which insulin forms would plans have to include under the Making Insulin Affordable for All Children Act?
Under the Making Insulin Affordable for All Children Act, plans must select at least one product in each dosage form, including forms like vials, pumps, and inhalers, for each insulin type (Section 2).
Do insulin copays under HR 2636 count toward the deductible or out-of-pocket maximum?
Yes. According to H.R. 2636 Section 2, cost-sharing paid for selected insulin must be counted toward any applicable plan deductible and out-of-pocket maximum.
Can catastrophic health plans make people under 26 pay full price for insulin before meeting the annual limit?
No. Under the Making Insulin Affordable for All Children Act, catastrophic plans must cover selected insulin products for individuals 26 or younger before the annual cost-sharing limitation is met (Section 2(c)).
Does HR 2636 cap insulin costs for people older than 26?
No. H.R. 2636 Section 2 is limited to enrolled individuals age 26 or younger and does not require the same coverage or cost-sharing limits for older individuals.
Does the 25% insulin cap under HR 2636 use the price after PBM rebates and discounts?
Yes. Under H.R. 2636 Section 2, the 25% cap is based on the negotiated price net of all price concessions, including concessions received by third-party entities such as pharmacy benefit managers.
Based on H.R. 2636 bill text
H.R. 2636 Bill Text
“To provide for appropriate cost-sharing for individuals 26 years of age or younger for insulin products covered under private health plans. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE. This Act may be cited as the “Making Insulin Affordable for All Children Act”.”
Source: U.S. Government Publishing Office
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