Text of Senate Amendment 6075

On 2026-06-24, Senator Jeanne Shaheen (D-NH) delivered a floor speech titled "Text Of Senate Amendment 6075" in the Senate.

Text of Senate Amendment 6075

Congressional Record, Volume 172 Issue 106 (Wednesday, June 24, 2026) [Congressional Record Volume 172, Number 106 (Wednesday, June 24, 2026)] [Senate] [Pages S3285-S3289] From the Congressional Record Online through the Government Publishing Office [ www.gpo.gov ] SA 6075. Mrs. SHAHEEN (for herself, Ms. Collins, Mr. Warnock, and Mr. Kennedy) submitted an amendment intended to be proposed by her to the bill S. 4784, to authorize appropriations for fiscal year 2027 for military activities of the Department of Defense, for military construction, and for defense activities of the Department of Energy, to prescribe military personnel strengths for such fiscal year, and for other purposes; which was ordered to lie on the table; as follows: At the end of title X, add the following: Subtitle H--Insulin Act SEC. 1099. SHORT TITLE; SENSE OF CONGRESS. (a) Short Title.--This subtitle may be cited as the ``Improving Needed Safeguards for Users of Lifesaving Insulin Now Act of 2026'' or the ``INSULIN Act of 2026''. (b) Sense of Congress.--It is the sense of Congress that Congress should enact subsequent legislation that provides for an offset for any costs to the Federal Government resulting from the enactment of this subtitle. CHAPTER 1--COMMERCIAL MARKET PATIENT PROTECTIONS SEC. 1099A. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN INSULIN PRODUCTS. (a) In General.--Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-111 et seq.) is amended by adding at the end the following: ``SEC. 2799A-12. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN INSULIN PRODUCTS. ``(a) In General.--For plan years beginning on or after January 1, 2027, a group health plan or health insurance issuer offering group or individual health insurance coverage shall provide coverage of selected insulin products, and with respect to such products, shall not-- ``(1) apply any deductible; or ``(2) impose any cost-sharing requirements in excess of, per 30-day supply-- ``(A) for any applicable plan year beginning before January 1, 2028, $35; or ``(B) for any plan year beginning on or after January 1, 2028, the lesser of-- ``(i) $35; or ``(ii) the amount equal to 25 percent of the negotiated price of the selected insulin product net of all price concessions received by or on behalf of the plan or issuer, including price concessions received by or on behalf of third-party entities providing services to the plan or issuer, such as pharmacy benefit management services or third party administrators. ``(b) Definitions.--In this section: ``(1) Selected insulin products.--The term `selected insulin products' means, for any plan year beginning on or after January 1, 2027, at least one of each dosage form (such as vial, pen, or inhaler dosage forms) of each different type (such as rapid-acting, short-acting, intermediate-acting, long-acting, and pre-mixed) of insulin, when such form is licensed and marketed, as selected by the group health plan or health insurance issuer. ``(2) Insulin.--The term `insulin' means insulin that is licensed under subsection (a) or (k) of section 351 and continues to be marketed pursuant to such licensure. ``(c) Out-of-Network Providers.--Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for selected insulin products described in this section that are delivered by an out-of-network provider, or precludes a plan or issuer that has a network of providers from imposing higher cost-sharing than the levels specified in subsection (a) for selected insulin products described in this section that are delivered by an out-of- network provider. ``(d) Rule of Construction.--Subsection (a) shall not be construed to require coverage of, or prevent a group health plan or health insurance issuer from imposing cost-sharing other than the levels specified in subsection (a) on, insulin products that are not selected insulin products, to the extent that such coverage is not otherwise required and such cost-sharing is otherwise permitted under Federal and applicable State law. ``(e) Application of Cost-Sharing Towards Deductibles and Out-of-Pocket Maximums.--Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan or coverage. ``(f) Other Requirements.--A group health plan or health insurance issuer offering group or individual health insurance coverage shall not impose, directly or through an entity providing pharmacy benefit management services, any prior authorization or other medical management requirement, or other similar conditions, on selected insulin products, except as clinically justified for safety reasons, to ensure reasonable quantity limits and as specified by the Secretary.''. (b) No Effect on Other Cost-Sharing.--Section 1302(d)(2) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(d)(2)) is amended by adding at the end the following new subparagraph: ``(D) Special rule relating to insulin coverage.--For plans years beginning on or after January 1, 2028, the exemption of coverage of selected insulin products (as defined in section 2799A-12(b) of the Public Health Service Act) from the application of any deductible pursuant to section 2799A- 12(a)(1) of such Act, section 727(a)(1) of the Employee Retirement Income Security Act of 1974, or section 9827(a)(1) of the Internal Revenue Code of 1986 shall not be considered when determining the actuarial value of a qualified health plan under this subsection.''. (c) Coverage of Certain Insulin Products Under Catastrophic Plans.--Section 1302(e) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(e)) is amended by adding at the end the following: ``(4) Coverage of certain insulin products.-- ``(A) In general.--Notwithstanding paragraph (1)(B)(i), for plan years beginning on or after January 1, 2027, a health plan described in paragraph (1) shall provide coverage of selected insulin products, in accordance with section 2799A- 12 of the Public Health Service Act, before an enrolled individual has incurred, during the plan year, cost-sharing expenses in an amount equal to the annual limitation in effect under subsection (c)(1) for the plan year. ``(B) Terminology.--For purposes of subparagraph (A)-- ``(i) the term `selected insulin products' has the meaning given such term in section 2799A-12(b) of the Public Health Service Act; and ``(ii) the requirements of section 2799A-12 of such Act shall be applied by deeming each reference in such section to `individual health insurance coverage' to be a reference to a plan described in paragraph (1).''. (d) ERISA.-- (1) In general.--Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following: ``SEC. 727. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR CERTAIN INSULIN PRODUCTS. ``(a) In General.--For plan years beginning on or after January 1, 2027, a group health plan or health insurance issuer offering group health insurance coverage shall provide coverage of selected insulin products, and with respect to such products, shall not-- ``(1) apply any deductible; or ``(2) impose any cost-sharing requirements in excess of, per 30-day supply-- ``(A) for any applicable plan year beginning before January 1, 2028, $35; or ``(B) for any plan year beginning on or after January 1, 2028, the lesser of-- ``(i) $35; or ``(ii) the amount equal to 25 percent of the negotiated price of the selected insulin product net of all price concessions received by or on behalf of the plan or issuer, including price concessions received by or on behalf of third-party entities providing services to the plan or issuer, such as pharmacy benefit management services or third party administrators. ``(b) Definitions.--In this section: ``(1) Selected insulin products.--The term `selected insulin products' means, for any plan year beginning on or after January 1, 2027, at least one of each dosage form (such as vial, pen, or inhaler dosage forms) of each different type (such as rapid-acting, short-acting, intermediate-acting, long-acting, and pre-mixed) of insulin, when such form is licensed and marketed, as selected by the group health plan or health insurance issuer. ``(2) Insulin.--The term `insulin' means insulin that is licensed under subsection (a) or (k) of section 351 of the Public Health Service Act (42 U.S.C. 262) and continues to be marketed pursuant to such licensure. ``(c) Out-of-Network Providers.--Nothing in this section requires a plan or issuer that has a network of providers to provide benefits for selected insulin products described in this section that are delivered by an out-of-network provider, or precludes a plan or issuer that has a network of providers from imposing higher cost-sharing than the levels specified in subsection (a) for selected insulin products described in this section that are delivered by an out-of- network provider. ``(d) Rule of Construction.--Subsection (a) shall not be construed to require coverage of, or prevent a group health plan or health insurance issuer from imposing cost-sharing other than the levels specified in subsection (a) on, insulin products that are not selected insulin products, to the extent that such coverage is not otherwise required and such cost-sharing is otherwise permitted under Federal and applicable State law. ``(e) Application of Cost-Sharing Towards Deductibles and Out-of-Pocket Maximums.--Any cost-sharing payments made pursuant to subsection (a)(2) shall be counted toward any deductible or out-of-pocket maximum that applies under the plan or coverage. ``(f) Other Requirements.--A group health plan or health insurance issuer offering [[Page S3286]] group health insurance coverage shall not impose, directly or through an entity providing pharmacy benefit management services, any prior authorization or other medic