II 

118TH CONGRESS 

1ST SESSION S. 954 

To provide for appropriate cost-sharing for insulin products covered under 

private health plans, and to establish a program to support health care 

providers and pharmacies in providing discounted insulin products to 

uninsured individuals. 

IN THE SENATE OF THE UNITED STATES 

MARCH 23, 2023 

Mr. WARNOCK (for himself and Mr. KENNEDY) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To provide for appropriate cost-sharing for insulin products 

covered under private health plans, and to establish a 

program to support health care providers and pharmacies 

in providing discounted insulin products to uninsured 

individuals. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Affordable Insulin Now 

5 Act of 2023’’. 


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1 SEC. 2. APPROPRIATE COST-SHARING FOR INSULIN PROD2 UCTS COVERED UNDER PRIVATE HEALTH 

3 PLANS. 

4 (a) IN GENERAL.—Part D of title XXVII of the Pub5 lic Health Service Act (42 U.S.C. 300gg–111 et seq.) is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 2799A–11. REQUIREMENTS WITH RESPECT TO COST8 SHARING FOR CERTAIN INSULIN PRODUCTS. 

9 ‘‘(a) IN GENERAL.—For plan years beginning on or 

10 after January 1, 2024, a group health plan or health in11 surance issuer offering group or individual health insur12 ance coverage shall provide coverage of selected insulin 

13 products, and with respect to such products, shall not— 

14 ‘‘(1) apply any deductible; or 

15 ‘‘(2) impose any cost-sharing in excess of the 

16 lesser of, per 30-day supply— 

17 ‘‘(A) $35; or 

18 ‘‘(B) the amount equal to 25 percent of 

19 the negotiated price of the selected insulin prod20 uct net of all price concessions received by or on 

21 behalf of the plan or coverage, including price 

22 concessions received by or on behalf of third23 party entities providing services to the plan or 

24 coverage, such as pharmacy benefit manage25 ment services. 

26 ‘‘(b) DEFINITIONS.—In this section: 


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1 ‘‘(1) SELECTED INSULIN PRODUCTS.—The term 

2 ‘selected insulin products’ means at least one of each 

3 dosage form (such as vial, pump, or inhaler dosage 

4 forms) of each different type (such as rapid-acting, 

5 short-acting, intermediate-acting, long-acting, ultra 

6 long-acting, and premixed) of insulin (as defined 

7 below), when available, as selected by the group 

8 health plan or health insurance issuer. 

9 ‘‘(2) INSULIN DEFINED.—The term ‘insulin’ 

10 means insulin that is licensed under subsection (a) 

11 or (k) of section 351 and continues to be marketed 

12 under such section. 

13 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—Nothing in 

14 this section requires a plan or issuer that has a network 

15 of providers to provide benefits for selected insulin prod16 ucts described in this section that are delivered by an out17 of-network provider, or precludes a plan or issuer that has 

18 a network of providers from imposing higher cost-sharing 

19 than the levels specified in subsection (a) for selected insu20 lin products described in this section that are delivered 

21 by an out-of-network provider. 

22 ‘‘(d) RULE OF CONSTRUCTION.—Subsection (a) shall 

23 not be construed to require coverage of, or prevent a group 

24 health plan or health insurance coverage from imposing 

25 cost-sharing other than the levels specified in subsection 


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1 (a) on, insulin products that are not selected insulin prod2 ucts, to the extent that such coverage is not otherwise re3 quired and such cost-sharing is otherwise permitted under 

4 Federal and applicable State law. 

5 ‘‘(e) APPLICATION OF COST-SHARING TOWARDS

6 DEDUCTIBLES AND OUT-OF-POCKET MAXIMUMS.—Any 

7 cost-sharing payments made pursuant to subsection (a)(2) 

8 shall be counted toward any deductible or out-of-pocket 

9 maximum that applies under the plan or coverage.’’. 

10 (b) NO EFFECT ON OTHER COST-SHARING.—Section 

11 1302(d)(2) of the Patient Protection and Affordable Care 

12 Act (42 U.S.C. 18022(d)(2)) is amended by adding at the 

13 end the following new subparagraph: 

14 ‘‘(D) SPECIAL RULE RELATING TO INSU15 LIN COVERAGE.—The exemption of coverage of 

16 selected insulin products (as defined in section 

17 2799A–11(b) of the Public Health Service Act) 

18 from the application of any deductible pursuant 

19 to section 2799A–11(a)(1) of such Act, section 

20 726(a)(1) of the Employee Retirement Income 

21 Security Act of 1974, or section 9826(a)(1) of 

22 the Internal Revenue Code of 1986 shall not be 

23 considered when determining the actuarial value 

24 of a qualified health plan under this sub25 section.’’. 


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1 (c) COVERAGE OF CERTAIN INSULIN PRODUCTS

2 UNDER CATASTROPHIC PLANS.—Section 1302(e) of the 

3 Patient Protection and Affordable Care Act (42 U.S.C. 

4 18022(e)) is amended by adding at the end the following: 

5 ‘‘(4) COVERAGE OF CERTAIN INSULIN PROD6 UCTS.— 

7 ‘‘(A) IN GENERAL.—Notwithstanding para8 graph (1)(B)(i), a health plan described in 

9 paragraph (1) shall provide coverage of selected 

10 insulin products, in accordance with section 

11 2799A–11 of the Public Health Service Act, be12 fore an enrolled individual has incurred, during 

13 the plan year, cost-sharing expenses in an 

14 amount equal to the annual limitation in effect 

15 under subsection (c)(1) for the plan year. 

16 ‘‘(B) TERMINOLOGY.—For purposes of 

17 subparagraph (A)— 

18 ‘‘(i) the term ‘selected insulin prod19 ucts’ has the meaning given such term in 

20 section 2799A–11(b) of the Public Health 

21 Service Act; and 

22 ‘‘(ii) the requirements of section 

23 2799A–11 of such Act shall be applied by 

24 deeming each reference in such section to 

25 ‘individual health insurance coverage’ to be 


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1 a reference to a plan described in para2 graph (1).’’. 

3 (d) ERISA.— 

4 (1) IN GENERAL.—Subpart B of part 7 of sub5 title B of title I of the Employee Retirement Income 

6 Security Act of 1974 (29 U.S.C. 1185 et seq.) is 

7 amended by adding at the end the following: 

8 ‘‘SEC. 726. REQUIREMENTS WITH RESPECT TO COST-SHAR9 ING FOR CERTAIN INSULIN PRODUCTS. 

10 ‘‘(a) IN GENERAL.—For plan years beginning on or 

11 after January 1, 2024, a group health plan or health in12 surance issuer offering group health insurance coverage 

13 shall provide coverage of selected insulin products, and 

14 with respect to such products, shall not— 

15 ‘‘(1) apply any deductible; or 

16 ‘‘(2) impose any cost-sharing in excess of the 

17 lesser of, per 30-day supply— 

18 ‘‘(A) $35; or 

19 ‘‘(B) the amount equal to 25 percent of 

20 the negotiated price of the selected insulin prod21 uct net of all price concessions received by or on 

22 behalf of the plan or coverage, including price 

23 concessions received by or on behalf of third24 party entities providing services to the plan or 


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1 coverage, such as pharmacy benefit manage2 ment services. 

3 ‘‘(b) DEFINITIONS.—In this section: 

4 ‘‘(1) SELECTED INSULIN PRODUCTS.—The term 

5 ‘selected insulin products’ means at least one of each 

6 dosage form (such as vial, pump, or inhaler dosage 

7 forms) of each different type (such as rapid-acting, 

8 short-acting, intermediate-acting, long-acting, ultra 

9 long-acting, and premixed) of insulin (as defined 

10 below), when available, as selected by the group 

11 health plan or health insurance issuer. 

12 ‘‘(2) INSULIN DEFINED.—The term ‘insulin’ 

13 means insulin that is licensed under subsection (a) 

14 or (k) of section 351 of the Public Health Service 

15 Act (42 U.S.C. 262) and continues to be marketed 

16 under such section. 

17 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—Nothing in 

18 this section requires a plan or issuer that has a network 

19 of providers to provide benefits for selected insulin prod20 ucts described in this section that are delivered by an out21 of-network provider, or precludes a plan or issuer that has 

22 a network of providers from imposing higher cost-sharing 

23 than the levels specified in subsection (a) for selected insu24 lin products described in this section that are delivered 

25 by an out-of-network provider. 


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1 ‘‘(d) RULE OF CONSTRUCTION.—Subsection (a) shall 

2 not be construed to require coverage of, or prevent a group 

3 health plan or health insurance coverage from imposing 

4 cost-sharing other than the levels specified in subsection 

5 (a) on, insulin products that are not selected insulin prod6 ucts, to the extent that such coverage is not otherwise re7 quired and such cost-sharing is otherwise permitted under 

8 Federal and applicable State law. 

9 ‘‘(e) APPLICATION OF COST-SHARING TOWARDS

10 DEDUCTIBLES AND OUT-OF-POCKET MAXIMUMS.—Any 

11 cost-sharing payments made pursuant to subsection (a)(2) 

12 shall be counted toward any deductible or out-of-pocket 

13 maximum that applies under the plan or coverage.’’. 

14 (2) CLERICAL AMENDMENT.—The table of con15 tents in section 1 of the Employee Retirement In16 come Security Act of 1974 (29 U.S.C. 1001 et seq.) 

17 is amended by inserting after the item relating to 

18 section 725 the following: 

‘‘Sec. 726. Requirements with respect to cost-sharing for certain insulin products.’’. 

19 (e) INTERNAL REVENUE CODE.— 

20 (1) IN GENERAL.—Subchapter B of chapter 

21 100 of the Internal Revenue Code of 1986 is amend22 ed by adding at the end the following new section: 


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1 ‘‘SEC. 9826. REQUIREMENTS WITH RESPECT TO COST-SHAR2 ING FOR CERTAIN INSULIN PRODUCTS. 

3 ‘‘(a) IN GENERAL.—For plan years beginning on or 

4 after January 1, 2024, a group health plan shall provide 

5 coverage of selected insulin products, and with respect to 

6 such products, shall not— 

7 ‘‘(1) apply any deductible; or 

8 ‘‘(2) impose any cost-sharing in excess of the 

9 lesser of, per 30-day supply— 

10 ‘‘(A) $35; or 

11 ‘‘(B) the amount equal to 25 percent of 

12 the negotiated price of the selected insulin prod13 uct net of all price concessions received by or on 

14 behalf of the plan, including price concessions 

15 received by or on behalf of third-party entities 

16 providing services to the plan, such as phar17 macy benefit management services. 

18 ‘‘(b) DEFINITIONS.—In this section: 

19 ‘‘(1) SELECTED INSULIN PRODUCTS.—The term 

20 ‘selected insulin products’ means at least one of each 

21 dosage form (such as vial, pump, or inhaler dosage 

22 forms) of each different type (such as rapid-acting, 

23 short-acting, intermediate-acting, long-acting, ultra 

24 long-acting, and premixed) of insulin (as defined 

25 below), when available, as selected by the group 

26 health plan. 


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1 ‘‘(2) INSULIN DEFINED.—The term ‘insulin’ 

2 means insulin that is licensed under subsection (a) 

3 or (k) of section 351 of the Public Health Service 

4 Act (42 U.S.C. 262) and continues to be marketed 

5 under such section. 

6 ‘‘(c) OUT-OF-NETWORK PROVIDERS.—Nothing in 

7 this section requires a plan that has a network of providers 

8 to provide benefits for selected insulin products described 

9 in this section that are delivered by an out-of-network pro10 vider, or precludes a plan that has a network of providers 

11 from imposing higher cost-sharing than the levels specified 

12 in subsection (a) for selected insulin products described 

13 in this section that are delivered by an out-of-network pro14 vider. 

15 ‘‘(d) RULE OF CONSTRUCTION.—Subsection (a) shall 

16 not be construed to require coverage of, or prevent a group 

17 health plan from imposing cost-sharing other than the lev18 els specified in subsection (a) on, insulin products that are 

19 not selected insulin products, to the extent that such cov20 erage is not otherwise required and such cost-sharing is 

21 otherwise permitted under Federal and applicable State 

22 law. 

23 ‘‘(e) APPLICATION OF COST-SHARING TOWARDS

24 DEDUCTIBLES AND OUT-OF-POCKET MAXIMUMS.—Any 

25 cost-sharing payments made pursuant to subsection (a)(2) 


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1 shall be counted toward any deductible or out-of-pocket 

2 maximum that applies under the plan.’’. 

3 (2) CLERICAL AMENDMENT.—The table of sec4 tions for subchapter B of chapter 100 of such Code 

5 is amended by adding at the end the following new 

6 item: 

‘‘Sec. 9826. Requirements with respect to cost-sharing for certain insulin products.’’. 

7 (f) IMPLEMENTATION.—The Secretary of Health and 

8 Human Services, the Secretary of Labor, and the Sec9 retary of the Treasury may implement the provisions of, 

10 including the amendments made by, this subsection 

11 through sub-regulatory guidance, program instruction or 

12 otherwise. 

13 SEC. 3. REIMBURSEMENT FOR INSULIN FURNISHED TO UN14 INSURED INDIVIDUALS. 

15 (a) IN GENERAL.—The Secretary of Health and 

16 Human Services (in this section referred to as the ‘‘Sec17 retary’’) shall establish a program under which the Sec18 retary enters into agreements with qualifying entities for 

19 purposes of furnishing insulin products to uninsured indi20 viduals. 

21 (b) PAYMENT.—The Secretary shall pay to each 

22 qualifying entity with an agreement in effect under this 

23 section, with respect to each 30-day supply of insulin prod24 ucts furnished to an uninsured individual by such entity 


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1 on or after January 1, 2024, an amount equal to the dif2 ference between the out-of-pocket cost to the individual for 

3 a 30-day supply of such insulin products and $35. 

4 (c) DEFINITIONS.—In this section: 

5 (1) INSULIN PRODUCT.—The term ‘‘insulin 

6 product’’ has the meaning given the term ‘‘insulin’’ 

7 in section 2799A–11 of the Public Health Service 

8 Act, as added by section 2. 

9 (2) QUALIFYING ENTITY.—The term ‘‘quali10 fying entity’’ means a health care provider or phar11 macy that— 

12 (A) agrees, with respect to an insulin prod13 uct furnished by such provider or pharmacy to 

14 an uninsured individual after January 1, 2024, 

15 for which payment is made by the Secretary 

16 under this section, not to hold such individual 

17 liable for any payment amount for such prod18 uct; and 

19 (B) meets such other standards and re20 quirements as may be determined appropriate 

21 by the Secretary. 

22 (3) SPECIFIED HEALTH PLAN.—The term 

23 ‘‘specified health plan’’ means a Federal health care 

24 program (as defined in section 1128B of the Social 

25 Security Act (42 U.S.C. 1320a–7b)), the health proVerDate Sep 11 2014 20:59 Apr 05, 2023 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S954.IS S954

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1 gram established under chapter 89 of title 5, United 

2 States Code, a group health plan (as defined in sec3 tion 2791 of the Public Health Service Act (42 

4 U.S.C. 300gg–91), and group or individual health 

5 insurance coverage (as defined in such section 

6 2791). 

7 (4) UNINSURED INDIVIDUAL.—The term ‘‘unin8 sured individual’’ means, with respect to an indi9 vidual and an insulin product, an individual who 

10 does not have benefits available for such product (or 

11 for another insulin product of the same dosage form 

12 (such as vial, pump, or inhaler dosage forms) and 

13 type (such as rapid-acting, short-acting, inter14 mediate-acting, long-acting, ultra-long-acting, and 

15 premixed)) under a specified health plan. 

16 SEC. 4. SENSE OF CONGRESS. 

17 It is the sense of Congress that subsequent legislation 

18 should be enacted by Congress that provides for an offset 

19 for any costs to the Federal Government resulting from 

20 the enactment of this Act. 

Æ 


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