Cap Insulin Prices Act

The Cap Insulin Prices Act (S.146) caps out-of-pocket costs for insulin under Medicare Part D and most private health insurance plans. Starting in 2024, it requires plans to cover "selected insulin products" (multiple types and forms, like rapid-acting or long-acting) with no deductible and cost-sharing limited to $25 per 30-day supply or 25% of the negotiated price, whichever is lower. The law applies to both Medicare Part D plans and private group/individual health insurance plans, including those governed by ERISA. It also specifies that cost-sharing payments count toward annual deductibles and out-of-pocket maximums. This directly affects millions of insulin users enrolled in Medicare or private coverage who previously faced high out-of-pocket costs.