Reimbursement for insulin furnished to uninsured individuals

(a) In general The Secretary of Health and Human Services (in this section referred to as the Secretary) shall establish a program under which the Secretary enters into agreements with qualifying entities for purposes of furnishing insulin products to uninsured individuals. (b) Payment The Secretary shall pay to each qualifying entity with an agreement in effect under this section, with respect to each 30-day supply of insulin products furnished to an uninsured individual by such entity on or after January 1, 2027, an amount equal to the difference between the out-of-pocket cost to the individual for a 30-day supply of such insulin products and $35. (c) Definitions In this section: (1) Insulin product The term insulin product has the meaning given the term insulin in section 2799A–12 of the Public Health Service Act, as added by section 2. (2) Qualifying entity The term qualifying entity means a health care provider or pharmacy that— (A) agrees, with respect to an insulin product furnished by such provider or pharmacy to an uninsured individual after January 1, 2027, for which payment is made by the Secretary under this section, not to hold such individual liable for any payment amount for such product; and (B) meets such other standards and requirements as may be determined appropriate by the Secretary. (3) Specified health plan The term specified health plan means a Federal health care program (as defined in section 1128B of the Social Security Act (42 U.S.C. 1320a–7b)), the health program established under chapter 89 of title 5, United States Code, a group health plan (as defined in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91)), and group or individual health insurance coverage (as defined in such section 2791). (4) Uninsured individual The term uninsured individual means, with respect to an individual and an insulin product, an individual who does not have benefits available for such product (or for another insulin product of the same dosage form (such as vial, pump, or inhaler dosage forms) and type (such as rapid-acting, short-acting, intermediate-acting, long-acting, ultra-long-acting, and premixed)) under a specified health plan.