A bipartisan group of senators is resurfacing legislation to cap many American patients’ insulin costs at $35 a month — the INSULIN Act of 2026 — reviving a push that previously stalled.
The bill, co-authored by Sens. Jeanne Shaheen, D-N.H., Susan Collins, R-Maine, Raphael Warnock, D-Ga., and John Kennedy, R-La., would bar group and individual health plans from imposing deductibles on selected insulin products and could not charge more than $35 for a 30-day supply starting in plan year 2027.
Beginning in 2028, patients would pay the lesser of $35 or 25% of the negotiated net price.
Congress had already mandated a Medicare-only cap of $35 in 2022, and President Donald Trump‘s long-running agenda to lower prescription medicine costs gives the effort some momentum before the 2026 midterms, where Collins’ seat could be targeted for a Democrat flip amid the very narrow Republican Senate majority (53-47).
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“We are the long-time chairs of the Senate Diabetes Caucus, and one of our top priorities is to make insulin more affordable,” Collins said in a Senate hearing last week.
“Our INSULIN Act would impose out-of-pocket limits for patients with commercial insurance, tackle commercial pharmacy benefit managers, and ensure that patients are the ones who are benefiting from the savings that they negotiate, and encourage biosimilar competition in order to lower list prices.”
The bill, first introduced in 2023, has been reworked at Kennedy and Warnock’s urging to include some work to provide capped insulin prices even for the uninsured.
“Our bill also includes provisions to help uninsured Americans access affordable insulin,” Collins continued. “Just this week, I met with a young woman who, a few years ago, ended up in the hospital because she was stretching out her insulin, not taking as much as she was prescribed, because she simply couldn’t afford the cost.”
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The issue aligns with a 2024 Trump presidential campaign vow. Trump has already announced other initiatives to lower prescription drug prices, including an executive order last May on his “Most Favored Nation” (MNF) policy to take action on Big Pharma companies that are not offering the world’s lowest price on drugs to Americans.
“Americans should not be forced to subsidize low-cost prescription drugs and biologics in other developed countries, and face overcharges for the same products in the United States,” Trump’s policy ordered. “Americans must therefore have access to the most-favored-nation price for these products.”
“My Administration will take immediate steps to end global freeloading and, should drug manufacturers fail to offer American consumers the most-favored-nation’s lowest price, my Administration will take additional aggressive action.”
Then, this December, Trump announced agreements with nine Big Pharma companies to lower prices on Americans under the MFN policy, including offering direct to the consumer lowest pricing on TrumpRx, the president’s new prescription drug portal.
TrumpRX lists Insulin Lispro from Eli Lilly for $25.
Collin and Shaheen’s legislation would also offer a limited cap on insulin for the uninsured — an issue reportedly driven by Warnock and Kennedy in the bipartisan group — creating a five-year pilot in 10 states to help uninsured patients get insulin for no more than $35 a month.
“We have already capped insulin for Medicare enrollees at $35 a month — this new INSULIN Act, which we plan to introduce next [this] week, will address insulin affordability for children, adults and those who are uninsured,” Shaheen said in a statement.
“It will do, as the Medicare provision does, cap the cost of employer and private insurance coverage of insulin at $35 a month, create a pilot program to provide $35 a month insulin for uninsured diabetes patients, and it is a direct way to help American families facing economic pressures, and will make people healthier in the long run.”
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While Collins might need the bill for her 2026 midterm election hopes, Shaheen is serving out her final year in the Senate.
“I would really like to be able to leave the Senate thinking that we had helped to address insulin costs for a lot of Americans: This is the most expensive chronic disease,” Shaheen told Semafor, noting Trump’s agenda for capping prices.
“This is something that he should support, because it is affordability.”
Affordability has been the Democrats’ buzzword for the midterms, but Republicans and Trump have argued it has only been an issue Democrats have made after years of inflation under former President Joe Biden.
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The bill authorizes $100 million for fiscal 2027 for cost-cutting and defines “affordable” insulin as out-of-pocket costs of no more than $35 for a one-month supply.
Collins framed the measure as a response to patients rationing medicine they need to survive.
“I have heard far too many stories from people in Maine and across the country who have been forced to ration their insulin because of the cost, and that is simply unacceptable,” she told Semafor.
Beyond the consumer cap, the bill also tries to lower underlying costs by targeting pharmacy benefit manager practices and encouraging more competition from biosimilars and generics. It orders a federal study on delays in bringing insulin products to market and barriers to biosimilar uptake.
The proposal now faces the harder political test: winning buy-in from Senate leadership and finding a path to must-pass legislation later this year. But after years of failed starts, backers say they finally have a bipartisan framework that could move.
