I 

118TH CONGRESS 

1ST SESSION H. R. 1587 

To provide for appropriate cost-sharing for individuals 26 years of age or 

younger for insulin products covered under private health plans and Medicaid. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 14, 2023 

Mr. LANDSMAN introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means, and Education and the 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 

A BILL 

To provide for appropriate cost-sharing for individuals 26 

years of age or younger for insulin products covered 

under private health plans and Medicaid. 

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 ‘‘Making Insulin Afford5 able for All Children Act’’. 


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1 SEC. 2. APPROPRIATE COST-SHARING FOR INDIVIDUALS 26 

2 YEARS OF AGE OR YOUNGER FOR INSULIN 

3 PRODUCTS COVERED UNDER PRIVATE 

4 HEALTH PLANS AND MEDICAID. 

5 (a) PRIVATE HEALTH PLANS.— 

6 (1) IN GENERAL.—Part D of title XXVII of the 

7 Public Health Service Act (42 U.S.C. 300gg–111 et 

8 seq.) is amended by adding at the end the following: 

9 ‘‘SEC. 2799A–11. REQUIREMENTS WITH RESPECT TO COST10 SHARING FOR CERTAIN INSULIN PRODUCTS. 

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

12 after January 1, 2024, a group health plan or health in13 surance issuer offering group or individual health insur14 ance coverage shall, with respect to enrolled individuals 

15 26 years of age or younger, provide coverage of selected 

16 insulin products, and with respect to such products, shall 

17 not— 

18 ‘‘(1) apply any deductible; or 

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

20 lesser of, per 30-day supply— 

21 ‘‘(A) $35; or 

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

23 the negotiated price of the selected insulin prod24 uct net of all price concessions received by or on 

25 behalf of the plan or coverage, including price 

26 concessions received by or on behalf of thirdVerDate Sep 11 2014 04:46 Mar 25, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1587.IH H1587

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1 party entities providing services to the plan or 

2 coverage, such as pharmacy benefit manage3 ment services. 

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

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

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

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

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

9 short-acting, intermediate-acting, long-acting, ultra 

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

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

12 health plan or health insurance issuer. 

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

14 means insulin that is licensed under subsection (a) 

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

16 under such section, including any insulin product 

17 that has been deemed to be licensed under section 

18 351(a) pursuant to section 7002(e)(4) of the Bio19 logics Price Competition and Innovation Act of 2009 

20 and continues to be marketed pursuant to such li21 censure. 

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

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

24 of providers to provide benefits for selected insulin prod25 ucts described in this section that are delivered by an outVerDate Sep 11 2014 04:46 Mar 25, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1587.IH H1587

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1 of-network provider, or precludes a plan or issuer that has 

2 a network of providers from imposing higher cost-sharing 

3 than the levels specified in subsection (a) for selected insu4 lin products described in this section that are delivered 

5 by an out-of-network provider. 

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

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

8 health plan or health insurance coverage from imposing 

9 cost-sharing other than the levels specified in subsection 

10 (a) on, insulin products that are not selected insulin prod11 ucts or insulin products for an individual not described 

12 in subsection (a), to the extent that such coverage is not 

13 otherwise required and such cost-sharing is otherwise per14 mitted under Federal and applicable State law. 

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

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

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

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

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

20 (2) NO EFFECT ON OTHER COST-SHARING.— 

21 Section 1302(d)(2) of the Patient Protection and Af22 fordable Care Act (42 U.S.C. 18022(d)(2)) is 

23 amended by adding at the end the following new 

24 subparagraph: 


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1 ‘‘(D) SPECIAL RULE RELATING TO INSU2 LIN COVERAGE.—The exemption of coverage of 

3 selected insulin products (as defined in section 

4 2799A–11(b) of the Public Health Service Act) 

5 from the application of any deductible pursuant 

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

7 726(a)(1) of the Employee Retirement Income 

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

9 the Internal Revenue Code of 1986 shall not be 

10 considered when determining the actuarial value 

11 of a qualified health plan under this sub12 section.’’. 

13 (3) COVERAGE OF CERTAIN INSULIN PRODUCTS

14 UNDER CATASTROPHIC PLANS.—Section 1302(e) of 

15 the Patient Protection and Affordable Care Act (42 

16 U.S.C. 18022(e)) is amended by adding at the end 

17 the following: 

18 ‘‘(4) COVERAGE OF CERTAIN INSULIN PROD19 UCTS.— 

20 ‘‘(A) IN GENERAL.—Notwithstanding para21 graph (1)(B)(i), a health plan described in 

22 paragraph (1) shall provide coverage of selected 

23 insulin products, with respect to an enrolled in24 dividual who is 26 years of age or younger, in 

25 accordance with section 2799A–11 of the Public 


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1 Health Service Act, before the enrolled indi2 vidual has incurred, during the plan year, cost3 sharing expenses in an amount equal to the an4 nual limitation in effect under subsection (c)(1) 

5 for the plan year. 

6 ‘‘(B) TERMINOLOGY.—For purposes of 

7 subparagraph (A)— 

8 ‘‘(i) the term ‘selected insulin prod9 ucts’ has the meaning given such term in 

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

11 Service Act; and 

12 ‘‘(ii) the requirements of section 

13 2799A–11 of such Act shall be applied by 

14 deeming each reference in such section to 

15 ‘individual health insurance coverage’ to be 

16 a reference to a plan described in para17 graph (1).’’. 

18 (4) ERISA.— 

19 (A) IN GENERAL.—Subpart B of part 7 of 

20 subtitle B of title I of the Employee Retirement 

21 Income Security Act of 1974 (29 U.S.C. 1185 

22 et seq.) is amended by adding at the end the 

23 following: 


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1 ‘‘SEC. 726. 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 or health in5 surance issuer offering group health insurance coverage 

6 shall, with respect to enrolled individuals 26 years of age 

7 or younger, provide coverage of selected insulin products, 

8 and with respect to such products, shall not— 

9 ‘‘(1) apply any deductible; or 

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

11 lesser of, per 30-day supply— 

12 ‘‘(A) $35; or 

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

14 the negotiated price of the selected insulin prod15 uct net of all price concessions received by or on 

16 behalf of the plan or coverage, including price 

17 concessions received by or on behalf of third18 party entities providing services to the plan or 

19 coverage, such as pharmacy benefit manage20 ment services. 

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

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

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

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

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

26 short-acting, intermediate-acting, long-acting, ultra 


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

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

3 health plan or health insurance issuer. 

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

5 means insulin that is licensed under subsection (a) 

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

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

8 under such section, including any insulin product 

9 that has been deemed to be licensed under section 

10 351(a) of such Act pursuant to section 7002(e)(4) 

11 of the Biologics Price Competition and Innovation 

12 Act of 2009 (Public Law 111–148) and continues to 

13 be marketed pursuant to such licensure. 

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

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

16 of providers to provide benefits for selected insulin prod17 ucts described in this section that are delivered by an out18 of-network provider, or precludes a plan or issuer that has 

19 a network of providers from imposing higher cost-sharing 

20 than the levels specified in subsection (a) for selected insu21 lin products described in this section that are delivered 

22 by an out-of-network provider. 

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

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

25 health plan or health insurance coverage from imposing 


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1 cost-sharing other than the levels specified in subsection 

2 (a) on, insulin products that are not selected insulin prod3 ucts or insulin products for an individual not described 

4 in subsection (a), to the extent that such coverage is not 

5 otherwise required and such cost-sharing is otherwise per6 mitted under Federal and applicable State law. 

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

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

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

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

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

12 (B) CLERICAL AMENDMENT.—The table of 

13 contents in section 1 of the Employee Retire14 ment Income Security Act of 1974 (29 U.S.C. 

15 1001 et seq.) is amended by inserting after the 

16 item relating to section 725 the following: 

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

17 (5) INTERNAL REVENUE CODE.— 

18 (A) IN GENERAL.—Subchapter B of chap19 ter 100 of the Internal Revenue Code of 1986 

20 is amended by adding at the end the following 

21 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, with re5 spect to enrolled individuals 26 years of age or younger, 

6 provide coverage of selected insulin products, and with re7 spect to such products, shall not— 

8 ‘‘(1) apply any deductible; or 

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

10 lesser of, per 30-day supply— 

11 ‘‘(A) $35; or 

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

13 the negotiated price of the selected insulin prod14 uct net of all price concessions received by or on 

15 behalf of the plan, including price concessions 

16 received by or on behalf of third-party entities 

17 providing services to the plan, such as phar18 macy benefit management services. 

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

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

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

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

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

24 short-acting, intermediate-acting, long-acting, ultra 

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


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

2 health plan. 

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

4 means insulin that is licensed under subsection (a) 

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

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

7 under such section, including any insulin product 

8 that has been deemed to be licensed under section 

9 351(a) of such Act pursuant to section 7002(e)(4) 

10 of the Biologics Price Competition and Innovation 

11 Act of 2009 (Public Law 111–148) and continues to 

12 be marketed pursuant to such licensure. 

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

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

15 to provide benefits for selected insulin products described 

16 in this section that are delivered by an out-of-network pro17 vider, or precludes a plan that has a network of providers 

18 from imposing higher cost-sharing than the levels specified 

19 in subsection (a) for selected insulin products described 

20 in this section that are delivered by an out-of-network pro21 vider. 

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

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

24 health plan from imposing cost-sharing other than the lev25 els specified in subsection (a) on, insulin products that are 


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1 not selected insulin products or insulin products for an 

2 individual not described in subsection (a), to the extent 

3 that such coverage is not otherwise required and such 

4 cost-sharing is otherwise permitted under Federal and ap5 plicable State law. 

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

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

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

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

10 maximum that applies under the plan.’’. 

11 (B) CLERICAL AMENDMENT.—The table of 

12 sections for subchapter B of chapter 100 of 

13 such Code is amended by adding at the end the 

14 following new item: 

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

15 (6) IMPLEMENTATION.—The Secretary of 

16 Health and Human Services, the Secretary of Labor, 

17 and the Secretary of the Treasury may implement 

18 the provisions of, including the amendments made 

19 by, this subsection through sub-regulatory guidance, 

20 program instruction or otherwise. 

21 (b) MEDICAID.—Section 1916 of the Social Security 

22 Act (42 U.S.C. 1396o) is amended— 

23 (1) in subsection (a)(3), by inserting before the 

24 period at the end the following: ‘‘; and except that, 


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1 beginning January 1, 2024, with respect to individ2 uals 26 years of age or younger, in the case of se3 lected insulin products (as defined in subsection (b) 

4 of section 2799A–11 of the Public Health Service 

5 Act), no deductible shall be applied and any cost6 sharing imposed shall not exceed the lesser of, per 

7 30-day supply, the amounts specified under sub8 section (a)(2) of such section’’; and 

9 (2) in subsection (b)(3), by inserting before the 

10 period at the end the following: ‘‘; and except that, 

11 beginning January 1, 2024, with respect to individ12 uals 26 years of age or younger, in the case of se13 lected insulin products (as defined in subsection (b) 

14 of section 2799A–11 of the Public Health Service 

15 Act), no deductible shall be applied and any cost16 sharing imposed shall not exceed the lesser of, per 

17 30-day supply, the amounts specified under sub18 section (a)(2) of such section’’. 

Æ 


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