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New Annual Cap on Out-of-Pocket Prescription Drug Costs under ACA

This bill amends the Patient Protection and Affordable Care Act to establish an annual limit on cost-sharing for prescription drugs. For plan years beginning on or after January 1, 2027, the cost-sharing incurred under a health plan for prescription drugs shall not exceed specified dollar amounts.
Key points
Establishes an annual limitation on cost-sharing for prescription drugs in health plans, effective for plan years beginning on or after January 1, 2027.
The limit for self-only coverage is set at $2,000 for 2027, while coverage other than self-only is set at twice that amount ($4,000).
For years subsequent to 2027, the limit will be increased based on the premium adjustment percentage.
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Status: Introduced
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Additional Information
Print number: 119_HR_6171
Sponsor: Rep. Auchincloss, Jake [D-MA-4]
System Note: Lustra is free, publicly auditable civic infrastructure — full source code available on GitHub. You are reading sterilized legislative data, processed by our radical neutrality engine to strip political spin and retain factual mechanics. We process only official government data. Original documents remain the authoritative source—always verify them if you can.
Summarized by: gemini-3-pro-preview
Source data: api.congress.gov
AI work logs for this document launch

OFFICIAL LEGAL TITLE

ACA Copay CAP Act of 2025

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 119_HR_6171.

Which chamber initiated this legislation?

This legislation was initiated in the House of Representatives.

What are the main provisions?

Key points include:

  • Establishes an annual limitation on cost-sharing for prescription drugs in health plans, effective for plan years beginning on or after January 1, 2027.
  • The limit for self-only coverage is set at $2,000 for 2027, while coverage other than self-only is set at twice that amount ($4,000).
  • For years subsequent to 2027, the limit will be increased based on the premium adjustment percentage.
What is the specific legal status?

The current status is Introduced.

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 Rep. Auchincloss, Jake [D-MA-4].

What is the latest detailed status?

The latest detailed status is: Referred to the House Committee on Energy and Commerce.

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-31.

What is the impact of this bill?

We don't know—that is up to you to decide. Summarizing raw data with AI is fundamentally different from predicting socio-economic outcomes. As of 2026, we believe impact assessment strictly requires a human in the loop to verify and judge.

CATEGORIES

Health