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Employers could face new federal rules for how their health plans cover insulin for children with diabetes.

The new Making Insulin Affordable for All Children Act bill would require any group health plan, including a self-insured health plan, to limit the monthly out-of-pocket cost of some types of insulin to less than $35 per month. The cap would apply to plan participants up to age 26.

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A plan could apply to "selected insulin products." Products available with the $35 monthly cap would have to include at least one of each dosage form, "such as vial, pump, or inhaler dosage forms," and one of each different type of insulin, "such as rapid-acting, short-acting, intermediate-acting, long-acting, ultra long-acting, and premixed."

Bill details: Rep. Greg Landsman, D-Ohio, a member of the U.S. House Diabetes Caucus, introduced the bill with five co-sponsors. All of the co-sponsors are Democrats.

The bill is under the jurisdiction of the House Energy and Commerce, Ways and Means and Education and the Workforce committees.

Landsman introduced a similar bill in the previous Congress. The earlier bill died in committee.

Insulin: In 2019, employer plan participants who used insulin spent an average of $82 per month out-of-pocket on their insulin prescriptions, and the prescriptions cost the participants and their employers a total of more than $5,000 per year, according to the Health Care Cost Institute.

Patients, federal antitrust regulators have argued that manufacturers, pharmacy benefit managers and other prescription drug distribution players may be colluding to push up what patients and employer plans really pay for insulin.

Medicare added a $35 cap on monthly out-of-pocket insulin costs for patients with some types of Medicare Part D prescription drug plans during President Donald Trump's first term in office.

Former President Joe Biden added a $35 monthly cap for insulin users in all Medicare Part D drug plans in 2022, when he signed the Inflation Reduction Act.

Related: Florida car dealer joins fight against Big Pharma insulin pricing

The Medicare plan insulin cap applied directly only to a small number of children who qualify for Medicare because they needed kidney dialysis or required a kidney transplant and had at least one parent who receives Social Security retirement benefits.

But insulin makers responded to criticism of insulin product prices by announcing efforts to provide insulin for all people with diabetes for less than $35 per month.

What employer plan participants are really paying out-of-pocket for insulin now is unclear. Patient groups contend that, in some cases, insulin products subject to official price caps or manufacturers' voluntary price caps tend to be in short supply. Shortages of insulin products with low prices may push patients to buy more expensive insulin products.

The age issue: Landsman said he wants his bill to keep families from having to make drastic decisions about care for children due to the cost of insulin. "No child should be deprived of care because of it," Landsman said.

But the bill could run into concerns related to age discrimination. Earlier this year, for example, a woman with hearing problems sued Cigna over plan rules that made hearing aid benefits available to children but not to adults.

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Allison Bell

Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.