H.R. 2636 — Making Insulin Affordable for All Children Act

This section requires, for plan years beginning on or after January 1, 2026, group health plans and health insurance issuers offering group or individual health insurance coverage to cover selected insulin products for enrolled individuals 26 years of age or younger without any deductible and with cost-sharing not exceeding the lesser of $35 or 25% of the net negotiated price per 30-day supply. Selected insulin products means at least one of each dosage form (e.g., vial, pump, inhaler) and type (e.g., rapid-acting, short-acting) of FDA-licensed insulin, as selected by the plan or issuer; such payments count toward deductibles and out-of-pocket maximums, but the requirement does not mandate coverage of or limit cost-sharing for non-selected insulin products. The section also (1) amends Affordable Care Act (ACA) Section 1302(d)(2) to exclude this insulin coverage from actuarial value calculations for qualified health plans; and (2) amends ACA Section 1302(e) to require such coverage under catastrophic plans before enrollees reach the annual cost-sharing limit. These requirements are codified via parallel provisions added to Part D of title XXVII of the Public Health Service Act (new Sec. 2799A-11), subpart B of part 7 of subtitle B of title I of ERISA (new Sec. 726), and the Internal Revenue Code (new Sec. 9826).