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Capping Prescription Costs Act of 2025
To limit cost-sharing for prescription drugs, and for other purposes.
Summary
This bill would establish annual caps on prescription drug cost-sharing for health insurance plans, effective for plan years beginning in 2026 or later. For 2026, the cap would be set at $2,000 per individual or $4,000 per family per year. Starting in 2027, the cap would be adjusted annually based on increases in the medical care component of the consumer price index, rounded to the nearest $5. The bill applies these caps to qualified health plans under the Affordable Care Act, group health plans covered under the Public Health Service Act, plans under the Employee Retirement Income Security Act, and plans under the Internal Revenue Code, creating a uniform prescription drug cost-sharing limit across these insurance types.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
9 cosponsors
- Del. Norton, Eleanor Holmes [D-DC-At Large] (D-DC)
- Rep. Cherfilus-McCormick, Sheila [D-FL-20] (D-FL)
- Rep. Figures, Shomari [D-AL-2] (D-AL)
- Rep. Hayes, Jahana [D-CT-5] (D-CT)
- Rep. Johnson, Henry C. "Hank" [D-GA-4] (D-GA)
- Rep. Stansbury, Melanie A. [D-NM-1] (D-NM)
- Rep. Thompson, Bennie G. [D-MS-2] (D-MS)
- Rep. Vasquez, Gabe [D-NM-2] (D-NM)
- Rep. Waters, Maxine [D-CA-43] (D-CA)
Actions (2)
- Apr 1, 2025 Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned. · house
- Apr 1, 2025 Introduced in House
More bills on these subjects (8)
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Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Text versions (1)
Bills are re-published as they move (Introduced → Reported → Engrossed → Enrolled …). Each stage below is a separate text; pick two to see what changed. Data from Congress.gov.
Full text
IN THE HOUSE OF REPRESENTATIVES
April 1, 2025
Mr. Horsford (for himself, Mr. Figures, Ms. Stansbury, Mr. Johnson of Georgia, Ms. Waters, Mrs. Cherfilus-McCormick, Mrs. Hayes, Mr. Thompson of Mississippi, and Ms. Norton) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
A BILL
To limit cost-sharing for prescription drugs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Capping Prescription Costs Act of 2025”.
SEC. 2. CAP ON PRESCRIPTION DRUG COST-SHARING.
(a) Qualified Health Plans.—Section 1302(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(c)) is amended—
(1) in paragraph (3)(A)(i), by inserting “, including cost-sharing with respect to prescription drugs covered by the plan” after “charges”; and
(2) by adding at the end the following:
“(5) Prescription drug cost-sharing.—
“(A) 2026.—For plan years beginning in 2026, the cost-sharing incurred under a health plan with respect to prescription drugs covered by the plan shall not exceed $2,000 per year for each enrolled individual, or $4,000 per year for each family.
“(B) 2027 and later.—
“(i) In general.—In the case of any plan year beginning in a calendar year after 2026, the limitation under this paragraph shall be equal to the applicable dollar amount under subparagraph (A) for plan years beginning in 2026, increased by an amount equal to the product of that amount and the medical care component of the consumer price index for all urban consumers (as published by the Bureau of Labor Statistics) for that year.
“(ii) Adjustment to amount.—If the amount of any increase under clause (i) is not a multiple of $5, such increase shall be rounded to the next lowest multiple of $5.”.
(b) Group Health Plans.—
(1) Public health service act.—Part D of title XXVII of the Public Health Service Act (42 U.S.C. 300gg-111 et seq.) is amended by inserting after section 2799A-5 (42 U.S.C. 300gg-
115) the following:
“SEC. 2799A-6. CAP ON PRESCRIPTION DRUG COST-SHARING FOR GROUP HEALTH PLANS.
“A group health plan and health insurance issuer offering group health insurance coverage shall ensure that any cost-sharing imposed under the plan or coverage with respect to prescription drugs covered by the plan or coverage does not exceed the limitations provided for under paragraph (5) of section 1302(c) of the Patient Protection and Affordable Care Act.”.
(2) Employee retirement income security act.—
(A) In general.—Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by inserting after section 720 (29 U.S.C. 1185i) the following:
“SEC. 721. CAP ON PRESCRIPTION DRUG COST-SHARING.
“A group health plan and health insurance issuer offering group health insurance coverage shall ensure that any cost-sharing imposed under the plan or coverage with respect to prescription drugs covered by the plan or coverage does not exceed the limitations provided for under paragraph (5) of section 1302(c) of the Patient Protection and Affordable Care Act.”.
(B) Clerical amendment.—The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended by inserting after the item relating to section 720 the following:
“Sec. 721. Cap on prescription drug cost-sharing.”.
(3) Internal revenue code of 1986.—
(A) In general.—Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by inserting after section 9820 the following:
“SEC. 9821. CAP ON PRESCRIPTION DRUG COST-SHARING.
“A group health plan shall ensure that any cost-sharing imposed under the plan with respect to prescription drugs covered by the plan does not exceed the limitations provided for under paragraph (5) of section 1302(c) of the Patient Protection and Affordable Care Act.”.
(B) Clerical amendment.—The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by inserting after the item relating to section 9820 the following:
“Sec. 9821. Cap on prescription drug cost-sharing”.
(c) Effective Date.—The amendments made by subsections (a) and (b) shall take effect with respect to plan years beginning on or after January 1, 2026. <all>
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