Congress caps insulin at $35 for young adults under 26 in private plans

What it does

This bill caps insulin cost-sharing for people under 26 in private health plans at $35 per 30-day supply (or 25% of the negotiated price, whichever is lower) starting January 2026, with no deductibles applied to selected insulin products. Plans must cover at least one insulin product in each dosage form and type. Young people with diabetes gain immediate affordability; insurers and pharmacy benefit managers absorb the cost difference between the cap and full negotiated price.

Why we flagged it

The bill's sole operative mechanism is a cost-sharing cap on insulin for people under 26 in private plans. It is a straightforward price regulation, not a subsidy, tax carve-out, or deregulation. The title accurately describes the function.

What the text implies

• Plans may respond by narrowing insulin formularies to the minimum required (one product per dosage form/type), reducing patient choice within the cap.
• The 25% negotiated-price alternative may incentivize plans to negotiate lower prices, potentially benefiting all patients, not just those under 26.
• Pharmacy benefit managers (PBMs) lose revenue from insulin cost-sharing spreads; they may shift costs to other drug categories or increase administrative fees.
• The rule applies to both group and individual market plans, but individual-market insurers may raise premiums for all enrollees to offset insulin losses.
• Catastrophic plans (high-deductible, low-premium) are explicitly required to cover selected insulins before the deductible, creating a carve-out that may make catastrophic plans more attractive to young diabetics.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Young people with diabetes (a chronic condition requiring lifelong medication) gain direct, substantial relief from high out-of-pocket costs. The $35 cap is a hard floor that protects against price volatility. No deductible waiver means insulin is accessible immediately, not after meeting a deductible. The cost shift to insurers is a legitimate public-health trade-off.

Who stands to gain

• young people with diabetes (direct cost relief)
• families with diabetic children under 26

Named in the bill

Health and Human Services (HHS), Department of Labor, Department of Treasury, Private health insurers, Pharmacy benefit managers (PBMs), Group health plans, Individual health insurance issuers

Where it stands

9 cosponsors: 9 Democrats.

• Apr 3, 2025 — Introduced · Congress.gov: “Introduced in House”
• Apr 3, 2025 — Referred to House Committee on Education and Workforce and House Committee on Ways and Means · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

1 lobbying clients named this bill on 1 disclosure filings across 1 quarter, Jun 2026 to Jun 2026. Those filings disclosed $3,010,000 in lobbying spend. A filing names 77 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 0% of bills with at least one filing.

Greg Landsman, the sponsor, reported $1,006,728 in PAC receipts in the 2026 cycle.

• America's Health Insurance Plans Inc (ahip) — $3,010,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.