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HB 6101

Insurance: health insurers; limit amount on co-pay for prescription insulin; provide for. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406qq.

2025-2026 Regular Session Introduced by Joey Andrews and 22 co-sponsors

Michigan caps insulin co-pays at $35 for a 30-day supply in selected products, with annual CPI increases beginning 2027.

bill electronically reproduced 06/17/2026
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Bill Summary · HB 6101

Summary of HB 6101 (2025-2026) — Michigan

Purpose and Intent

  • The bill aims to lower out-of-pocket costs for insulin by establishing a maximum co-pay or coinsurance amount for insulin products covered by health insurance policies issued in Michigan.
  • Specifically, it sets a cap of $35 for a 30-day supply of insulin products in defined categories, with annual CPI adjustments starting July 1, 2027.

Key Provisions and Changes

  • Co-pay/coinsurance Cap: For each 30-day supply of insulin products designated as "selected insulin products" by the insurer, the co-pay or coinsurance must not exceed $35. This applies to at least one insulin product in each of the following categories:

    • Rapid-acting
    • Short-acting
    • Intermediate-acting
    • Long-acting
    • Ultra-long-acting
    • Premixed

  • Limitations on Evasion Tactics: Insurers cannot meet the cap by:

    • Increasing other cost-sharing requirements for non-insulin benefits
    • Reclassifying insulin benefits to avoid the cap
    • Imposing more restrictive treatment limitations on insulin products

  • Allowance for Lower Costs: Insurers may:

    • Reduce the co-pay/coinsurance for a covered selected insulin product to any amount below $35
    • Charge higher cost-sharing for a covered non-insulin benefit, provided the non-insulin cost-sharing does not exceed $35 per 30-day supply

  • Annual CPI Adjustment: Beginning July 1, 2027, and on each July 1 thereafter, the $35 cap (and related provisions) will be adjusted in line with the Consumer Price Index (CPI) for the Detroit-Warren-Dearborn area, as published by the U.S. Bureau of Labor Statistics.

  • Definitions:

    • "Consumer Price Index": Most comprehensive index available for the Detroit-Warren-Dearborn area.
    • "Cost-sharing requirement": Includes deductibles, copayments, coinsurance, out-of-pocket expenses, and annual/lifetime limits.
    • "Selected insulin product": An insulin product chosen by the insurer in accordance with the statute.

  • Applicability: The act applies to health insurance policies delivered, executed, issued, amended, adjusted, or renewed in Michigan, including policies issued outside the state if they cover Michigan residents, with an effective date for the cap starting after June 30, 2026.

Who Is Affected

  • Insurers: Health insurers issuing or renewing policies in Michigan will be subject to the insulin co-pay/coinsurance cap and related constraints.
  • Policyholders/Beneficiaries: Individuals with insulin prescriptions covered under these policies, particularly those with 30-day insulin supplies, may see lower out-of-pocket costs.
  • Insured Residents Crossing Policies: Those with plans issued outside Michigan but covering Michigan residents are also affected.

Procedural and Timeline Details

  • Introduction and Referral: Introduced June 17, 2026; referred to the House Committee on Insurance.
  • Effective Date of Cap: The cap provisions apply to policies renewed or issued after June 30, 2026.
  • CPI Adjustment Timeline: Adjustments to the cap occur annually starting July 1, 2027, and each July 1 thereafter.

Financial and Practical Implications

  • The measure is designed to reduce immediate out-of-pocket costs for insulin for a broad set of insurance plans, potentially improving adherence and reducing financial barriers for people who rely on insulin.
  • CPI-based adjustments aim to maintain purchasing power over time, though impact will depend on future CPI changes.
  • The bill explicitly prohibits insurers from using plan design tricks to bypass the cap, protecting beneficiaries from shifting costs to other insulin-related or non-insulin benefits.

If you’d like, I can provide a one-page quick-read summary or a side-by-side comparison with existing Michigan insurance law for context.

Compiled from official sources — confirm details with the bill’s official record.

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