Ways and Means Committee, Energy and Commerce Committee, Education and Workforce Committee
Introduced
In Committee
On Floor
Passed Chamber
Enacted
This legislation aims to significantly limit the financial burden of prescription drug costs for consumers by establishing annual caps on out-of-pocket spending. It mandates that health plans ensure individuals and families face predictable expenses for covered prescription drugs. Specifically, for plan years beginning in 2026, the bill sets a maximum cost-sharing limit of $2,000 per year for each enrolled individual and $4,000 per year for each family . These limits will be adjusted annually for inflation in subsequent years, based on the medical care component of the consumer price index. The provisions apply broadly to qualified health plans under the Affordable Care Act, as well as to group health plans and health insurance issuers regulated under the Public Health Service Act, ERISA, and the Internal Revenue Code, taking effect for plan years beginning on or after January 1, 2026.
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.
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.
This legislation aims to significantly limit the financial burden of prescription drug costs for consumers by establishing annual caps on out-of-pocket spending. It mandates that health plans ensure individuals and families face predictable expenses for covered prescription drugs. Specifically, for plan years beginning in 2026, the bill sets a maximum cost-sharing limit of $2,000 per year for each enrolled individual and $4,000 per year for each family . These limits will be adjusted annually for inflation in subsequent years, based on the medical care component of the consumer price index. The provisions apply broadly to qualified health plans under the Affordable Care Act, as well as to group health plans and health insurance issuers regulated under the Public Health Service Act, ERISA, and the Internal Revenue Code, taking effect for plan years beginning on or after January 1, 2026.
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.
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.