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Cap on Prescription Drug Costs: Annual Out-of-Pocket Limits for Citizens.

This Act establishes maximum annual out-of-pocket spending limits for prescription drugs for individuals covered by qualified health plans and group health plans. Starting in 2026, the maximum cost for prescription drugs will be $2,000 per year for an individual and $4,000 for a family, protecting citizens from unexpected, high treatment costs. These limits will be adjusted annually based on the medical inflation rate.
Key points
Spending limit on drugs: Starting in 2026, the maximum annual out-of-pocket cost for covered prescription drugs will be $2,000 per enrolled individual.
Family limit: The maximum annual out-of-pocket cost for covered prescription drugs for a family will be capped at $4,000.
Inflation adjustment: These limits will be adjusted annually based on the medical care component of the consumer price index to maintain their real value.
Effective date: The changes apply to plan years beginning after December 31, 2025, affecting qualified health plans and group health plans.
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Additional Information
Print number: 118_S_4671
Sponsor: Sen. Casey, Robert P., Jr. [D-PA]
Process start date: 2024-07-11
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Summarized by: gemini-flash-latest
Source data: api.congress.gov
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OFFICIAL LEGAL TITLE

Capping Prescription Costs Act of 2024

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 118_S_4671.

Which chamber initiated this legislation?

This legislation was initiated in the Senate.

When did the legislative process begin?

The process officially started on 2024-07-11.

What are the main provisions?

Key points include:

  • Spending limit on drugs: Starting in 2026, the maximum annual out-of-pocket cost for covered prescription drugs will be $2,000 per enrolled individual.
  • Family limit: The maximum annual out-of-pocket cost for covered prescription drugs for a family will be capped at $4,000.
  • Inflation adjustment: These limits will be adjusted annually based on the medical care component of the consumer price index to maintain their real value.
  • Effective date: The changes apply to plan years beginning after December 31, 2025, affecting qualified health plans and group health plans.
What is the specific legal status?

The current status is Expired.

Where can I read the full text of this legislation?

The full official text is available at: View full text

Who is the primary sponsor?

The primary sponsor is Sen. Casey, Robert P., Jr. [D-PA].

What is the latest detailed status?

The latest detailed status is: Introduced in Senate

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-26.

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