Congress caps insulin at $35—but only for the insured
H.R. 6255 — Affordable Insulin Now Act · Filed by Angie Craig (D-MN) · 9 cosponsors · Introduced Nov 21, 2025 · Referred to committee
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What it does
This bill caps insulin cost-sharing at $35 per 30-day supply (or 25% of negotiated price, whichever is lower) for people with health insurance, effective January 1, 2026. It applies to group plans, individual coverage, and catastrophic plans, and requires insurers to cover at least one insulin product in each dosage form and type. The cap does not apply to out-of-network providers or non-selected insulin products.
Why we flagged it
The bill's core mechanism is a straightforward price ceiling on insulin cost-sharing across multiple insurance frameworks (PHSA, IRC, ERISA). It is consumer-protection legislation, not a tax measure, subsidy, or deregulation.
What the text implies
- Insurers may respond by narrowing formularies or raising premiums on other drugs to offset insulin losses, shifting costs elsewhere in the health system.
- The $35 cap applies only to 'selected' insulin products chosen by the plan, not all insulins—plans retain discretion to limit choice and may steer patients toward cheaper formulations.
The full analysis lists 4 implications of this text.
Who stands to gain
insulin-dependent patients (direct); pharmacy benefit managers (may gain negotiating leverage); health insurers (may benefit from reduced claims if patients use more insulin due to affordability)