Capping Prescription Costs Act of 2025

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:

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.

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.

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.

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:

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.

Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act (29 U.S.C. 1185 et seq.) is amended by inserting after section 720 (29 U.S.C. 1185i) the following:

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.

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:

Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by inserting after section 9820 the following:

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.

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:

The amendments made by subsections (a) and (b) shall take effect with respect to plan years beginning on or after January 1, 2026.