I 
117TH CONGRESS 
1ST SESSION H. R. 4158 
To amend titles XVIII and XIX of the Social Security Act to eliminate 
cost sharing with respect to coverage of insulin as a covered part D 
drug under the Medicare program or as a covered outpatient drug under 
the Medicaid program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 24, 2021 
Mr. RUSH (for himself, Ms. ADAMS, Ms. BARRAGA´N, Ms. BASS, Mrs. BEATTY, 
Mr. BISHOP of Georgia, Ms. BONAMICI, Mr. BROWN, Mr. BUTTERFIELD, 
Ms. CLARKE of New York, Mr. COHEN, Mr. DANNY K. DAVIS of Illinois, 
Mrs. DEMINGS, Mrs. DINGELL, Mr. EVANS, Mr. GARCI´A of Illinois, Ms. 
GARCIA of Texas, Mr. GRIJALVA, Mrs. HAYES, Ms. JOHNSON of Texas, 
Mr. JOHNSON of Georgia, Ms. KELLY of Illinois, Mr. KRISHNAMOORTHI, 
Ms. LEE of California, Mr. MEEKS, Ms. MENG, Ms. NORTON, Mr. 
PAYNE, Mr. RASKIN, Ms. ROYBAL-ALLARD, Mr. RUPPERSBERGER, Mr. 
SABLAN, Ms. SCHAKOWSKY, Ms. SEWELL, Mr. SIRES, Mr. TAKANO, Mr. 
THOMPSON of Mississippi, Ms. TLAIB, and Mr. VEASEY) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend titles XVIII and XIX of the Social Security Act 
to eliminate cost sharing with respect to coverage of 
insulin as a covered part D drug under the Medicare 
program or as a covered outpatient drug under the Med-
icaid program. 
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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 ‘‘Insulin Access for All 
Act of 2021’’. 
SEC. 2. ELIMINATING COST SHARING WITH RESPECT TO 
COVERAGE OF INSULIN AS A COVERED PART 
D DRUG UNDER THE MEDICARE PROGRAM 
OR 
AS 
A 
COVERED 
OUTPATIENT 
DRUG 
UNDER THE MEDICAID PROGRAM. 
(a) MEDICARE.— 
(1) ELIMINATION OF COST SHARING FOR INSU-
LIN AND CERTAIN ASSOCIATED MEDICAL SUPPLIES 
FURNISHED TO PART D ELIGIBLE INDIVIDUALS.— 
Section 1860D–2 of the Social Security Act (42 
U.S.C. 1395w–102) is amended— 
(A) in subsection (b)— 
(i) in paragraph (1)(A), by striking 
‘‘The coverage’’ and inserting ‘‘Subject to 
paragraph (8), the coverage’’; 
(ii) in paragraph (2)— 
(I) in subparagraph (A), by in-
serting after ‘‘Subject to subpara-
graphs (C) and (D)’’ the following: 
‘‘and paragraph (8)’’; 
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(II) in subparagraph (C)(i), by 
striking ‘‘paragraph (4)’’ and insert-
ing ‘‘paragraphs (4) and (8)’’; and 
(III) in subparagraph (D)(i), by 
striking ‘‘paragraph (4)’’ and insert-
ing ‘‘paragraphs (4) and (8)’’; 
(iii) in paragraph (4)(A)(i), by strik-
ing ‘‘The coverage’’ and inserting ‘‘Subject 
to paragraph (8), the coverage’’; and 
(iv) by adding at the end the following 
new paragraph: 
‘‘(8) ELIMINATION OF COST SHARING FOR CER-
TAIN COVERED PART D DRUGS.—The coverage does 
not impose any deductible, copayment, coinsurance, 
or other cost sharing for insulin (as described in 
subparagraph (B) of subsection (e)(1)) or medical 
supplies associated with the injection of insulin (as 
described in such subparagraph).’’; and 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(4) SAME ELIMINATION OF COST SHARING FOR 
CERTAIN COVERED PART D DRUGS.—The coverage is 
in accordance with subsection (b)(8).’’. 
(2) ELIMINATION OF COST SHARING FOR INSU-
LIN AND CERTAIN ASSOCIATED MEDICAL SUPPLIES 
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FURNISHED TO PART D ELIGIBLE INDIVIDUALS WHO 
ARE
SUBSIDY
ELIGIBLE
INDIVIDUALS.—Section 
1860D–14(a) of the Social Security Act (42 U.S.C. 
1395w–114(a)) is amended— 
(A) in paragraph (1)— 
(i) in subparagraph (D)— 
(I) in clause (ii), by striking ‘‘In 
the case of’’ and inserting ‘‘Subject to 
subparagraph (F), in the case of’’; 
and 
(II) in clause (iii), by striking 
‘‘In the case of’’ and inserting ‘‘Sub-
ject to subparagraph (F), in the case 
of’’; and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(F) ELIMINATION OF COST SHARING FOR 
CERTAIN COVERED PART D DRUGS.—Coverage 
that is in accordance with section 1860D– 
2(b)(8).’’; and 
(B) in paragraph (2)— 
(i) in subparagraph (D), by striking 
‘‘The substitution’’ and inserting ‘‘Subject 
to subparagraph (F), the substitution’’; 
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(ii) in subparagraph (E), by inserting 
after ‘‘Subject to’’ the following: ‘‘subpara-
graph (F) and’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) ELIMINATION OF COST SHARING FOR 
CERTAIN COVERED PART D DRUGS.—Coverage 
that is in accordance with section 1860D– 
2(b)(8).’’. 
(3) APPLICABILITY.—The amendments made 
by this subsection shall apply with respect to insulin, 
and medical supplies associated with the injection of 
insulin, furnished on or after January 1, 2022. 
(b) MEDICAID.— 
(1) IN GENERAL.—Section 1916 of the Social 
Security Act (42 U.S.C. 1396o) is amended— 
(A) in subsection (a)(2)— 
(i) in subparagraph (H), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (I), by striking ‘‘; 
and’’ and inserting ‘‘, or’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(J) insulin furnished as a covered out-
patient drug (as defined in section 1927(k)(2)) 
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and medical supplies associated with the injec-
tion of such insulin; and’’; and 
(B) in subsection (b)(2)— 
(i) in subparagraph (H), by striking 
‘‘or’’ at the end; 
(ii) in subparagraph (I), by striking ‘‘; 
and’’ and inserting ‘‘, or’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(J) insulin furnished as a covered out-
patient drug (as defined in section 1927(k)(2)) 
and medical supplies associated with the injec-
tion of such insulin; and’’. 
(2) ALTERNATIVE
COST
SHARING
LIMITA-
TION.—Section 1916A(c)(2) of the Social Security 
Act (42 U.S.C. 1396o–1(c)(2)) is amended by add-
ing at the end the following new subparagraph: 
‘‘(D) NONAPPLICABILITY OF COST SHAR-
ING
TO
INSULIN.—In no case may the cost 
sharing under paragraph (1)(A) apply with re-
spect to insulin furnished as a covered out-
patient drug (as defined in section 1927(k)(2)) 
and medical supplies associated with the injec-
tion of such insulin.’’. 
(3) EFFECTIVE DATE.— 
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(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sub-
section shall apply with respect to covered out-
patient drugs furnished on or after January 1, 
2022. 
(B) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) that the Secretary of Health and 
Human Services determines requires State leg-
islation in order for the respective plan to meet 
any requirement imposed by amendments made 
by this subsection, the respective plan shall not 
be regarded as failing to comply with the re-
quirements of such title solely on the basis of 
its failure to meet such an additional require-
ment before the first day of the first calendar 
quarter beginning after the close of the first 
regular session of the State legislature that be-
gins after the date of the enactment of this Act. 
For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative ses-
sion, each year of the session shall be consid-
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ered to be a separate regular session of the 
State legislature. 
Æ 
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