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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
Capping Prescription Costs Act of 2024
Print number: S 4671
Sponsor: Sen. Casey, Robert P., Jr. [D-PA]
Process start date: 2024-07-11