The bill would impose private-sector mandates 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 and requiring coverage of certified insulin products. CBO estimates that the average annual cost to comply with the mandates would exceed the private-sector threshold established in UMRA ($184 million in 2022, adjusted annually for inflation).
On March 30, 2022, CBO transmitted a cost estimate (www.cbo.gov/publication/57957) for H.R. 6833, the Affordable Insulin Now Act, as posted on the website of the House Committee on Rules on March 28, 2022. That legislation also would limit cost sharing for certain insulin products covered by private health insurance plans in the commercial market and under Medicare Part D. In addition, it would delay implementation of a rule related to manufacturer rebates in Part D and increase funding for the Medicare Improvement Fund (MIF). CBO estimated that H.R. 6833 would have no net effect on the federal deficit over 10 years and that the insulin-related provisions of the bill would increase federal deficits by $11.4 billion over that period. This estimate for the Senate legislation reflects the differences between the two bills including an estimated increase in the average net price of insulin resulting from the certification process, an estimated increase in Medicaid spending resulting from a reduction in rebates paid by insulin manufacturers, and changes to limits on cost sharing. The Senate legislation also does not include the provisions that would delay implementation of the rule related to manufacturer rebates or increase funding for the MIF.