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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.
article Official text account_balance Process page
Introduced
Citizen Poll
No votes cast
Additional Information
Print number: 119_HR_6171
Sponsor: Rep. Auchincloss, Jake [D-MA-4]
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Summarized by: gemini-3-pro-preview
Source data: api.congress.gov
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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.

CATEGORIES

Health