Two-year-old Bain Brandon, who has Type 1 diabetes, needs insulin to live, but his family’s costs remain burdensome even with coverage. His mother, Marlee Brandon, said a one-month supply of insulin vials and a three-month supply of backup pens for her Mississippi toddler cost $194 last week, and she worries about what happens when Bain grows older and can no longer rely on their insurance.
The bipartisan group behind the newly introduced INSULIN Act says it is designed to relieve that pressure on families like the Brandons and others who face high out-of-pocket costs for insulin. The bill would cap the cost of insulin at $35 per month for Americans with private insurance plans, and it would start a pilot program that aims to expand access to more affordable insulin for uninsured Americans in 10 states.
The legislation is the latest effort by lawmakers of both parties to lower insulin prices. Advocates and clinicians cited in the reporting say insulin costs vary widely, with some people paying nothing or very little under their private coverage while others still pay hundreds of dollars each month on top of other expenses related to diabetes management. Dr. Leslie Eiland, an adult endocrinologist at the University of Nebraska Medical Center who is advocating for the bill with the Endocrine Society, said the situation places “the onus on the patient” to navigate and try to reduce costs.
Some patients and organizations also argue that savings programs and manufacturer price changes do not always reach everyone. Matthew Fiedler, a senior fellow at the Brookings Institution’s Center on Health Policy, said that about 57% of Americans with private health insurance have self-insured plans that states can’t regulate, leaving them out of state cost-cap efforts aimed at patients with state-regulated insurance. He also pointed to barriers affecting uninsured patients and patients who may have trouble accessing savings programs.
In addition to the proposed $35 private-insurance cap, the bill draws comparisons to a Medicare price cap that took effect through the Biden-era Inflation Reduction Act. That 2022 law capped insulin at $35 per month for older adults on Medicare. The INSULIN Act would extend the approach to private insurance and add an uninsured-focused program, proponents said, as insulin maker competition and changes in affordability strategies continue to evolve.
The bill also faces practical obstacles in Congress. Even with bipartisan support, efforts to pass similar measures have not always succeeded, including a 2022 House-passed bill that would have applied the $35 monthly insulin cap to Americans with private insurance but did not pass the Senate. Another attempt to include the cap in the Inflation Reduction Act failed after Republicans opposed it, according to the reporting.
Companies in the insulin market and the pharmaceutical industry have offered views on access and affordability as policymakers consider new price limits. Oliver Bogillot, Sanofi’s head of general medicines for North America, said in a statement that “no one should struggle to afford their insulin” and pointed to the company’s savings program, which includes people without health insurance. Flavia Brakling, a spokesperson for Novo Nordisk, said expanding affordable access to medicine is a priority and noted the company hasn’t raised list prices for its insulin products for 2026.
PhRMA, the pharmaceutical industry trade group, also weighed in through a spokesperson, saying pharmacy benefit managers and insurers can create access and affordability barriers for patients even as manufacturers seek to expand access. Chanse Jones, a PhRMA spokesperson, said he “look forward to working with policymakers to ensure middlemen don’t stand between patients and their medicines.”
Despite the hurdles, people living with diabetes and advocacy groups described reasons to keep pushing. Breana Glover, a 23-year-old restaurant server in Houston with Type 1 diabetes, said she moved to Texas from California for cheaper living expenses tied to high health costs, and she described limiting her carbohydrate intake to make insulin last longer while paying a $50 co-pay for four vials each month. Manny Hernandez, CEO of The Diabetes Link, a national nonprofit for young adults with diabetes, said he was encouraged by meetings with Republican members of Congress from Florida, while also warning that other priorities have in the past drowned out insulin-cost legislation.
The INSULIN Act was introduced last week by Sens. Jeanne Shaheen, D-N.H., Raphael Warnock, D-Ga., Susan Collins, R-Maine, and John Kennedy, R-La., with the aim of building a rare bipartisan path toward health affordability in a politically competitive year.