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 Com-
mittee 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 con-
cerned 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Making Insulin Afford-
able for All Children Act’’. 
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SEC. 2. APPROPRIATE COST-SHARING FOR INDIVIDUALS 26 
YEARS OF AGE OR YOUNGER FOR INSULIN 
PRODUCTS 
COVERED 
UNDER 
PRIVATE 
HEALTH PLANS AND MEDICAID. 
(a) PRIVATE HEALTH PLANS.— 
(1) IN GENERAL.—Part D of title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg–111 et 
seq.) is amended by adding at the end the following: 
‘‘SEC. 2799A–11. REQUIREMENTS WITH RESPECT TO COST- 
SHARING FOR CERTAIN INSULIN PRODUCTS. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2024, a group health plan or health in-
surance issuer offering group or individual health insur-
ance coverage shall, with respect to enrolled individuals 
26 years of age or younger, provide coverage of selected 
insulin products, and with respect to such products, shall 
not— 
‘‘(1) apply any deductible; or 
‘‘(2) impose any cost-sharing in excess of the 
lesser of, per 30-day supply— 
‘‘(A) $35; or 
‘‘(B) the amount equal to 25 percent of 
the negotiated price of the selected insulin prod-
uct net of all price concessions received by or on 
behalf of the plan or coverage, including price 
concessions received by or on behalf of third- 
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party entities providing services to the plan or 
coverage, such as pharmacy benefit manage-
ment services. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) SELECTED INSULIN PRODUCTS.—The term 
‘selected insulin products’ means at least one of each 
dosage form (such as vial, pump, or inhaler dosage 
forms) of each different type (such as rapid-acting, 
short-acting, intermediate-acting, long-acting, ultra 
long-acting, and premixed) of insulin (as defined 
below), when available, as selected by the group 
health plan or health insurance issuer. 
‘‘(2) INSULIN
DEFINED.—The term ‘insulin’ 
means insulin that is licensed under subsection (a) 
or (k) of section 351 and continues to be marketed 
under such section, including any insulin product 
that has been deemed to be licensed under section 
351(a) pursuant to section 7002(e)(4) of the Bio-
logics Price Competition and Innovation Act of 2009 
and continues to be marketed pursuant to such li-
censure. 
‘‘(c) OUT-OF-NETWORK
PROVIDERS.—Nothing in 
this section requires a plan or issuer that has a network 
of providers to provide benefits for selected insulin prod-
ucts described in this section that are delivered by an out- 
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of-network provider, or precludes a plan or issuer that has 
a network of providers from imposing higher cost-sharing 
than the levels specified in subsection (a) for selected insu-
lin products described in this section that are delivered 
by an out-of-network provider. 
‘‘(d) RULE OF CONSTRUCTION.—Subsection (a) shall 
not be construed to require coverage of, or prevent a group 
health plan or health insurance coverage from imposing 
cost-sharing other than the levels specified in subsection 
(a) on, insulin products that are not selected insulin prod-
ucts or insulin products for an individual not described 
in subsection (a), to the extent that such coverage is not 
otherwise required and such cost-sharing is otherwise per-
mitted under Federal and applicable State law. 
‘‘(e) APPLICATION
OF
COST-SHARING
TOWARDS 
DEDUCTIBLES
AND OUT-OF-POCKET MAXIMUMS.—Any 
cost-sharing payments made pursuant to subsection (a)(2) 
shall be counted toward any deductible or out-of-pocket 
maximum that applies under the plan or coverage.’’. 
(2) NO EFFECT ON OTHER COST-SHARING.— 
Section 1302(d)(2) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18022(d)(2)) is 
amended by adding at the end the following new 
subparagraph: 
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‘‘(D) SPECIAL RULE RELATING TO INSU-
LIN COVERAGE.—The exemption of coverage of 
selected insulin products (as defined in section 
2799A–11(b) of the Public Health Service Act) 
from the application of any deductible pursuant 
to section 2799A–11(a)(1) of such Act, section 
726(a)(1) of the Employee Retirement Income 
Security Act of 1974, or section 9826(a)(1) of 
the Internal Revenue Code of 1986 shall not be 
considered when determining the actuarial value 
of a qualified health plan under this sub-
section.’’. 
(3) COVERAGE OF CERTAIN INSULIN PRODUCTS 
UNDER CATASTROPHIC PLANS.—Section 1302(e) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18022(e)) is amended by adding at the end 
the following: 
‘‘(4) COVERAGE
OF
CERTAIN
INSULIN
PROD-
UCTS.— 
‘‘(A) IN GENERAL.—Notwithstanding para-
graph (1)(B)(i), a health plan described in 
paragraph (1) shall provide coverage of selected 
insulin products, with respect to an enrolled in-
dividual who is 26 years of age or younger, in 
accordance with section 2799A–11 of the Public 
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