Health Service Act, before the enrolled indi-
vidual has incurred, during the plan year, cost- 
sharing expenses in an amount equal to the an-
nual limitation in effect under subsection (c)(1) 
for the plan year. 
‘‘(B) TERMINOLOGY.—For purposes of 
subparagraph (A)— 
‘‘(i) the term ‘selected insulin prod-
ucts’ has the meaning given such term in 
section 2799A–11(b) of the Public Health 
Service Act; and 
‘‘(ii) the requirements of section 
2799A–11 of such Act shall be applied by 
deeming each reference in such section to 
‘individual health insurance coverage’ to be 
a reference to a plan described in para-
graph (1).’’. 
(4) ERISA.— 
(A) IN GENERAL.—Subpart B of part 7 of 
subtitle B of title I of the Employee Retirement 
Income Security Act of 1974 (29 U.S.C. 1185 
et seq.) is amended by adding at the end the 
following: 
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‘‘SEC. 726. REQUIREMENTS WITH RESPECT TO COST-SHAR-
ING 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 health insurance 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- 
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 
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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 of the Public Health Service 
Act (42 U.S.C. 262) and continues to be marketed 
under such section, including any insulin product 
that has been deemed to be licensed under section 
351(a) of such Act pursuant to section 7002(e)(4) 
of the Biologics Price Competition and Innovation 
Act of 2009 (Public Law 111–148) and continues to 
be marketed pursuant to such licensure. 
‘‘(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- 
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 
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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.’’. 
(B) CLERICAL AMENDMENT.—The table of 
contents in section 1 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 
1001 et seq.) is amended by inserting after the 
item relating to section 725 the following: 
‘‘Sec. 726. Requirements with respect to cost-sharing for certain insulin prod-
ucts.’’. 
(5) INTERNAL REVENUE CODE.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following 
new section: 
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‘‘SEC. 9826. REQUIREMENTS WITH RESPECT TO COST-SHAR-
ING FOR CERTAIN INSULIN PRODUCTS. 
‘‘(a) IN GENERAL.—For plan years beginning on or 
after January 1, 2024, a group health plan shall, with re-
spect to enrolled individuals 26 years of age or younger, 
provide coverage of selected insulin products, and with re-
spect 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, including price concessions 
received by or on behalf of third-party entities 
providing services to the plan, such as phar-
macy benefit management 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 
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kjohnson on DSK79L0C42PROD with BILLS
below), when available, as selected by the group 
health plan. 
‘‘(2) INSULIN
DEFINED.—The term ‘insulin’ 
means insulin that is licensed under subsection (a) 
or (k) of section 351 of the Public Health Service 
Act (42 U.S.C. 262) and continues to be marketed 
under such section, including any insulin product 
that has been deemed to be licensed under section 
351(a) of such Act pursuant to section 7002(e)(4) 
of the Biologics Price Competition and Innovation 
Act of 2009 (Public Law 111–148) and continues to 
be marketed pursuant to such licensure. 
‘‘(c) OUT-OF-NETWORK
PROVIDERS.—Nothing in 
this section requires a plan that has a network of providers 
to provide benefits for selected insulin products described 
in this section that are delivered by an out-of-network pro-
vider, or precludes a plan that has a network of providers 
from imposing higher cost-sharing than the levels specified 
in subsection (a) for selected insulin products described 
in this section that are delivered by an out-of-network pro-
vider. 
‘‘(d) RULE OF CONSTRUCTION.—Subsection (a) shall 
not be construed to require coverage of, or prevent a group 
health plan from imposing cost-sharing other than the lev-
els specified in subsection (a) on, insulin products that are 
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not selected insulin products 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 permitted under Federal and ap-
plicable 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.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections for subchapter B of chapter 100 of 
such Code is amended by adding at the end the 
following new item: 
‘‘Sec. 9826. Requirements with respect to cost-sharing for certain insulin prod-
ucts.’’. 
(6) 
IMPLEMENTATION.—The 
Secretary 
of 
Health and Human Services, the Secretary of Labor, 
and the Secretary of the Treasury may implement 
the provisions of, including the amendments made 
by, this subsection through sub-regulatory guidance, 
program instruction or otherwise. 
(b) MEDICAID.—Section 1916 of the Social Security 
Act (42 U.S.C. 1396o) is amended— 
(1) in subsection (a)(3), by inserting before the 
period at the end the following: ‘‘; and except that, 
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beginning January 1, 2024, with respect to individ-
uals 26 years of age or younger, in the case of se-
lected insulin products (as defined in subsection (b) 
of section 2799A–11 of the Public Health Service 
Act), no deductible shall be applied and any cost- 
sharing imposed shall not exceed the lesser of, per 
30-day supply, the amounts specified under sub-
section (a)(2) of such section’’; and 
(2) in subsection (b)(3), by inserting before the 
period at the end the following: ‘‘; and except that, 
beginning January 1, 2024, with respect to individ-
uals 26 years of age or younger, in the case of se-
lected insulin products (as defined in subsection (b) 
of section 2799A–11 of the Public Health Service 
Act), no deductible shall be applied and any cost- 
sharing imposed shall not exceed the lesser of, per 
30-day supply, the amounts specified under sub-
section (a)(2) of such section’’. 
Æ 
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