H.R. 6833 would impose limits on private health insurance plans and plans offering coverage under Medicare Part D with respect to insulin products. Under the bill, Medicare beneficiaries would pay no more than $35 for each 30-day insulin prescription. Cost sharing for beneficiaries in private plans would be limited to the lesser of $35 or 25 percent of the plan’s negotiated price for a 30-day prescription. In addition, plans would be required to offer first-dollar coverage of insulin, without any deductible. H.R. 6833 also would delay for one year the implementation of a rule affecting the treatment of pharmaceutical manufacturers’ rebates in Medicare Part D and increase funding for the Medicare Improvement Fund.
H.R. 6833 would impose a private-sector mandate as defined in the Unfunded Mandates Reform Act (UMRA) by capping the amount that certain group and individual health insurance plans may require enrollees to pay out of pocket for insulin products. CBO estimates that the average annual cost to comply with the mandate would be $2 billion and would exceed the private-sector threshold established in UMRA ($170 million in 2021, adjusted annually for inflation).
Components may not sum to totals because of rounding.
