I 
119TH CONGRESS 
1ST SESSION H. R. 2636 
To provide for appropriate cost-sharing for individuals 26 years of age or 
younger for insulin products covered under private health plans. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 3, 2025 
Mr. LANDSMAN (for himself, Ms. NORTON, Ms. DEAN of Pennsylvania, Mr. 
MCGARVEY, Mr. THOMPSON of Mississippi, and Mr. GOTTHEIMER) intro-
duced 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 Workforce, for a period to be subsequently deter-
mined 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. 
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. 
(a) IN GENERAL.—Part D of title XXVII of the Pub-
lic 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, 2026, 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- 
party entities providing services to the plan or 
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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) 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-
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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. 
‘‘(d) 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) NO EFFECT ON OTHER COST-SHARING.—Section 
1302(d)(2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18022(d)(2)) is amended by adding at the 
end the following new subparagraph: 
‘‘(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.’’. 
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(c) 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 
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 
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deeming each reference in such section to 
‘individual health insurance coverage’ to be 
a reference to a plan described in para-
graph (1).’’. 
(d) ERISA.— 
(1) IN GENERAL.—Subpart B of part 7 of sub-
title 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: 
‘‘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, 2026, 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 
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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 
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) RULE OF CONSTRUCTION.—Subsection (a) shall 
not be construed to require coverage of, or prevent a group 
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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. 
‘‘(d) 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) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of the Employee Retirement In-
come 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.’’. 
(e) INTERNAL REVENUE CODE.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986 is amend-
ed 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, 2026, 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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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) 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 
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. 
‘‘(d) APPLICATION
OF
COST-SHARING
TOWARDS 
DEDUCTIBLES
AND OUT-OF-POCKET MAXIMUMS.—Any 
cost-sharing payments made pursuant to subsection (a)(2) 
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shall be counted toward any deductible or out-of-pocket 
maximum that applies under the plan.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions 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.’’. 
(f) IMPLEMENTATION.—The Secretary of Health and 
Human Services, the Secretary of Labor, and the Sec-
retary of the Treasury may implement the provisions of, 
including the amendments made by, this subsection 
through sub-regulatory guidance, program instruction or 
otherwise. 
Æ 
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