If you’ve seen headlines about Congress introducing a new $35 insulin cap, you might be wondering whether your prescriptions are about to get cheaper.
For people who rely on insulin every day, that could make a big difference. But there’s an important detail getting lost in some of the headlines.
Congress has proposed new legislation to limit insulin costs for people with private health insurance, but it has not become law.
That means the proposed federal $35 cap isn’t available to privately insured patients yet.
However, some people already have access to $35 insulin protections through Medicare, state laws, or manufacturer assistance programs.
Here’s what the new INSULIN Act would do, where it stands in Congress, and how you may be able to save money on insulin right now.
What Is the INSULIN Act?
The INSULIN Act is a federal legislative proposal intended to make insulin more affordable and improve access for people who need it.
In 2026, lawmakers introduced companion legislation in the House and Senate:
- H.R. 10227: Introduced in the House of Representatives on September 2, 2026, by Representative Diana DeGette of Colorado.
- S. 4189: Introduced in the Senate on March 25, 2026, by Senator Jeanne Shaheen of New Hampshire.
The legislation has received bipartisan support, but neither bill has completed the process required to become federal law.
The proposal focuses on reducing out-of-pocket insulin expenses for people with private health insurance, including certain employer-sponsored and individual health plans.
It also includes measures intended to improve insulin access for people without health insurance.
However, these proposed benefits are not currently available under the INSULIN Act because Congress has not enacted it.
Would the INSULIN Act Cap Insulin at $35?
Yes, but the proposed rules are more specific than some headlines suggest.
The legislation would establish new cost-sharing protections for certain insulin products covered by qualifying private health insurance plans.
During an initial period, the proposal would generally limit eligible insulin cost-sharing to $35 for a 30-day supply.
For plan years beginning on or after January 1, 2028, the proposed limit would generally become the lower of:
- $35 for a 30-day supply.
- 25% of the insulin product’s negotiated net price.
The proposal also includes protections intended to prevent deductibles from creating additional upfront costs for certain covered insulin products.
That means qualifying patients would not necessarily have to satisfy their plan’s regular deductible before receiving the proposed cost-sharing protection.
However, there’s an important limitation.
The bill would not necessarily require every private insurance plan to cover every insulin product on the market.
Instead, the legislation includes specific requirements involving covered insulin types and dosage forms.
Your particular insulin prescription and insurance plan would still matter.
And because the bill hasn’t passed, none of these proposed changes can be claimed as an existing federal benefit for private insurance.
Does Medicare Already Have a $35 Insulin Cap?
Yes. Medicare already has a $35 insulin cost-sharing limit under existing federal law.
This protection is separate from the proposed INSULIN Act.
The Inflation Reduction Act established insulin cost-sharing protections for qualifying Medicare beneficiaries.
Medicare Part D
If you have Medicare Part D prescription drug coverage, your out-of-pocket cost for a covered insulin product is generally limited to $35 for a one-month supply.
The Part D deductible does not apply to covered insulin products.
This protection also applies to qualifying Medicare Advantage plans that include Part D prescription drug coverage.
However, the medication must be covered under your plan.
Not every insulin product is necessarily included on every plan’s formulary.
Medicare Part B
Certain insulin products used with covered insulin pumps may be covered under Medicare Part B instead of Part D.
For qualifying Part B-covered insulin, Medicare also limits beneficiary cost-sharing to no more than $35 for a month’s supply.
The Part B deductible does not apply to that covered insulin.
What If You Use More Than One Insulin?
The $35 limit generally applies to each covered insulin product’s one-month supply.
It does not necessarily mean that someone using multiple insulin products will pay only $35 total for all of them.
For example, if your treatment requires two different covered insulin products, separate cost-sharing amounts may apply.
If you’re unsure whether your insulin is covered under Part B or Part D, contact your Medicare plan or Medicare directly.
You can reach Medicare at 1-800-MEDICARE (1-800-633-4227).
What About People With Private Insurance?
This is the group the proposed INSULIN Act is primarily intended to help.
Unlike Medicare, private health insurance does not currently have a universal federal $35 insulin cost-sharing cap.
That means your insulin costs may depend on:
- Your insurance company’s formulary.
- Your deductible.
- Your prescription copayment or coinsurance.
- The specific insulin your healthcare provider prescribes.
- Whether your state has its own insulin cost-sharing protections.
Some states have already enacted laws limiting insulin costs for certain private health insurance plans.
However, these state laws vary considerably.
They may apply only to specific types of insurance and may not cover self-funded employer health plans, which are generally regulated under federal law.
If you have private insurance and pay more than $35 for insulin, check whether your state has an applicable cost-sharing law.
You can also ask your insurer whether a lower-cost covered insulin alternative is available.
What Would the INSULIN Act Do for Uninsured People?
The legislation also includes provisions intended to help people who don’t have health insurance.
These include proposals for federal insulin information resources and a program intended to improve access to affordable insulin for eligible uninsured individuals.
One proposed measure involves a pilot program that could make certain insulin products available for approximately $35 under specified conditions.
However, the pilot program would have its own eligibility and participation requirements.
It would not necessarily provide a nationwide $35 insulin benefit to every uninsured person.
Most importantly, these proposed programs have not been established through the INSULIN Act.
If you don’t have insurance and need affordable insulin today, you shouldn’t wait for this legislation to become law.
There are existing manufacturer assistance programs and other resources that may help.
We’ll explain those options below.
Has the INSULIN Act Passed Congress?
No.
As of October 12, 2026, neither the House nor Senate version of the INSULIN Act has become law.
The two bills have followed different legislative paths.
House Bill H.R. 10227
The House version was introduced on September 2, 2026.
It was referred to committee for consideration.
A committee referral is an early stage in the legislative process.
The bill has not been approved by the full House of Representatives.
Senate Bill S. 4189
The Senate version was introduced on March 25, 2026.
It advanced through the Senate Health, Education, Labor, and Pensions Committee in July 2026.
On August 7, 2026, the bill was placed on the Senate legislative calendar.
This means the legislation has completed an important committee stage and is eligible for further Senate consideration.
However, being placed on the Senate calendar does not mean a bill has passed the Senate.
The full Senate has not approved the legislation.
What Needs to Happen Next?
Before the proposed insulin protections can become federal law, Congress must complete several steps.
Generally, the House and Senate must approve identical legislative language.
The legislation must then be presented to the President for signature or other constitutional action.
Until the required process is completed, the proposed private-insurance insulin cap does not take effect.
You can follow the official legislative status through Congress.gov.
When Would the New $35 Insulin Cap Start?
There is no confirmed start date for the proposed private-insurance protections because the legislation has not become law.
The bill includes a proposed cost-sharing structure for plan years beginning on or after January 1, 2028.
However, that date is part of the legislative proposal.
It is not a guarantee that the law will take effect in 2028.
Congress could change the bill’s language, effective dates, or other requirements before approving it.
The legislation could also remain pending without becoming law.
For now, people with private insurance should continue using the benefits and assistance programs currently available to them.
How Can You Get Cheaper Insulin Right Now?
You don’t have to wait for Congress to act before looking for ways to lower your insulin costs.
Several existing programs may provide assistance, depending on your income, insurance coverage, and medication.
1. Medicare’s Existing $35 Insulin Cap
If you have Medicare, check whether your insulin is covered under Part D or Part B.
You may already qualify for the federal $35 monthly cost-sharing limit for covered insulin products.
If your pharmacy is charging more than expected, contact your plan to review the prescription, coverage rules, and billing.
2. Manufacturer Insulin Assistance Programs
Major insulin manufacturers offer programs that may reduce prescription costs for qualifying patients.
These include programs from:
- Eli Lilly
- Novo Nordisk
- Sanofi
Depending on the manufacturer and program, eligible patients may qualify for lower-cost insulin, savings cards, or free medication.
Some programs are designed for people with commercial insurance, while others focus on uninsured or financially eligible patients.
Eligibility restrictions vary, and not every program is available to people with government insurance.
You can find more information in our Free Insulin & Cheap Diabetic Supplies guide.
3. Community Health Centers
Federally qualified health centers and other community clinics may offer healthcare services based on a patient’s ability to pay.
Some centers also provide access to discounted prescription medications or assistance enrolling in medication support programs.
If you’re uninsured or struggling with medical expenses, ask a nearby community health center about insulin affordability resources.
Availability depends on the clinic and the medications it can provide.
4. State Insulin Cost-Sharing Laws
Some states already limit insulin copayments for certain health insurance plans.
Depending on where you live and what type of insurance you have, you may qualify for a state-level insulin cost-sharing protection.
These laws can have important exceptions, so check whether your particular plan is covered.
5. Other Prescription Assistance Programs
You may also qualify for prescription assistance through nonprofit organizations, state pharmaceutical assistance programs, or other healthcare resources.
Some programs have income limits or require applicants to meet specific insurance conditions.
If you’re unsure where to begin, our complete insulin assistance guide explains additional options for finding affordable insulin and diabetic supplies.
What If You Can’t Afford Your Insulin Today?
If you’re having trouble paying for insulin, don’t stop taking it or change your dosage on your own to make your supply last longer.
Skipping insulin or taking less than prescribed can cause dangerous blood sugar problems.
Instead, contact your healthcare provider or pharmacist and explain that cost is preventing you from getting your medication.
They may be able to help you identify a covered alternative, connect you with an assistance program, or find another medically appropriate option.
If you’re already out of insulin or at risk of running out, seek medical guidance promptly.
You can also review our Free Insulin & Cheap Diabetic Supplies guide for programs that may help reduce your costs.
How Can You Track the INSULIN Act?
Because the legislation is still pending, its status could change.
You can monitor the bills through their official congressional records:
- H.R. 10227: House version of the INSULIN Act.
- S. 4189: Senate version of the INSULIN Act.
Congress.gov provides information about bill actions, committee consideration, amendments, and votes.
When reviewing updates, remember that a bill being introduced, approved by committee, or placed on a legislative calendar does not mean it has become law.
The proposed $35 private-insurance cap would only become enforceable after the legislation is enacted and the applicable provisions take effect.
Relief Recap
There is a real proposal in Congress to limit insulin costs for people with private health insurance.
The INSULIN Act would establish new cost-sharing protections for certain covered insulin products, including a proposed $35 limit for a 30-day supply.
However, as of October 12, 2026, the legislation has not passed Congress and is not federal law.
The Senate version has advanced through committee, but additional legislative action is still required.
In the meantime, Medicare already has a $35 monthly cost-sharing limit for covered insulin products under Part D and certain Part B coverage.
Some privately insured patients may also qualify for protections under state laws, while manufacturer programs and other assistance resources may help people who are uninsured or struggling with prescription costs.
If you’re having trouble affording insulin today, you don’t need to wait for a new federal law to explore your options.
Start with our Free Insulin & Cheap Diabetic Supplies guide to find programs that may help you get the medication and supplies you need.
