Bipartisan Senate Push Revives $35 Insulin Cap for Private Insurance and Uninsured Patients
Key Insights
A bipartisan group of 26 senators, led by Susan Collins and Jeanne Shaheen, is advancing legislation to cap insulin costs at $35 per month for privately insured and uninsured Americans.
The INSULIN Act (S. 4189) builds on the 2022 law that capped insulin costs for Medicare beneficiaries but left gaps in employer-sponsored plans and the uninsured population.
Senate HELP Committee Chair Bill Cassidy has signaled the bill could be considered in July, though concerns about redundancy with existing PBM legislation must first be resolved.
A renewed bipartisan effort in the Senate is gaining traction to extend the $35 monthly cap on insulin costs to Americans covered by private insurance and those who are uninsured, addressing a coverage gap left by Democrats' 2022 tax-and-healthcare law that applied the cap only to Medicare beneficiaries.
The legislation, known as the INSULIN Act (S. 4189), is being spearheaded by Sen. Susan Collins (R-Maine) and Sen. Jeanne Shaheen (D-N.H.), co-chairs of the Senate Diabetes (search) Caucus. Collins, who faces a tough reelection battle this fall, announced last week that two additional co-sponsors had signed on, bringing total support to 14 Republican senators and 12 Democrats.
"Every day we're gaining momentum," Collins said of the growing support. "There's a hole here that we want to plug, and that is for people on employer plans and people who are uninsured."
The proposal mirrors the insulin cost-sharing cap that Democrats included in the Inflation Reduction Act of 2022, which limited out-of-pocket insulin costs to $35 per month for seniors enrolled in Medicare's prescription drug program. That provision left millions of Americans with employer-sponsored health plans or without insurance exposed to significantly higher costs for the essential diabetes (search) medication.
Bipartisan Coalition Takes Shape
The bill has attracted a broad coalition of Republican co-sponsors, including Sens. Dave McCormick (R-Pa.), Tommy Tuberville (R-Ala.), Lisa Murkowski (R-Alaska), Jim Banks (R-Ind.), Chuck Grassley (R-Iowa), and Cindy Hyde-Smith (R-Miss.). Earlier this year, Collins and Shaheen successfully brought Sens. Raphael Warnock (D-Ga.) and John Kennedy (R-La.) — who had been working on rival insulin legislation — into their effort.
Shaheen's office has stated there is now sufficient bipartisan backing for the legislation to pass the Senate. "My hope is that we can get it on the mark-up calendar for July," said Collins, who serves on the Senate Health, Education, Labor and Pensions (HELP) Committee.
The measure previously earned support from seven Republicans when an earlier version was considered, and the expanded backing could represent a rare bipartisan achievement in what has been a deeply divided Congress.
Legislative Pathway and Hurdles
Senate Majority Leader John Thune (R-S.D.) has expressed openness to bringing the bill to the floor. "I know it's something that has a lot of support, so we'll see," Thune said. "Looking for things to do that have broad bipartisan support, that could be one of them." However, Thune indicated he wants the legislation to advance through committee first.
In mid-June, Sen. Bernie Sanders (I-Vt.) advanced the insulin bill by successfully attaching it to a bipartisan generic drug bill during a HELP Committee markup, securing some Republican support. However, Senate HELP Committee Chair Bill Cassidy (R-La.) — who backed the Democratic version of the private-market $35 insulin cap in 2022 — held up the generics bill over concerns that a pharmacy benefit manager (PBM) provision might duplicate legislation passed in February.
Cassidy indicated the insulin bill could be reconsidered in July. "My staff is meeting with Collins' and Shaheen's teams," Cassidy said. "We don't want to be redundant of that which is already passed into law." Collins confirmed the staff-level meeting and said she expected it to occur soon.
Even if the bill clears the Senate's legislative hurdles, it will still require majority support in the House, where some key Republican members have expressed openness to curbing insulin costs.