Proposed $2,000 Annual Cap on Prescription Drug Costs

Where This Stands

Introduced

Committee

Floor Vote

Passed

Signed

Currently IN_COMMITTEE. The next step in the legislative lifecycle is Floor Vote.

Version history

Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.

View official text →

The Frame

What this does

If passed, this legislation would establish a maximum annual financial liability for prescription medications for millions of Americans enrolled in private health insurance, shifting costs above the cap from the patient to the insurance plan.

Who is mentioned in the record

Potentially affected actors named in the source documents. Mention is not a position.

Health insurance enrollees

Individuals and families covered by qualified health plans or group health plans would have their annual out-of-pocket prescription drug costs capped.

Health insurance providers

Insurance plans would be required to adjust their cost-sharing structures to comply with the new annual caps on prescription drug expenses.

What changed

Current stage: IN_COMMITTEE.

What's next

Floor Vote.

Summary

This bill would limit the amount individuals and families pay out-of-pocket for prescription drugs under most private health insurance plans to $2,000 per year starting in 2026. It requires both individual market plans and s to cap these costs, with annual adjustments for inflation starting in 2027.

Key Facts

You don't have to trust us. Each fact below is taken straight from the official document - click any one to see the exact passage, highlighted in the original.

Why It Matters

If passed, this legislation would establish a maximum annual financial liability for prescription medications for millions of Americans enrolled in private health insurance, shifting costs above the cap from the patient to the insurance plan.

Frequently Asked Questions

Does this cap apply to all health insurance plans?

The bill amends the Patient Protection and Affordable Care Act and the Public Health Service Act to cover s and s.

When would these caps take effect?

The caps would apply to plan years beginning after December 31, 2025.

Will the $2,000 cap stay the same forever?

No, starting in 2027, the cap will increase annually based on the .

News Coverage

No news coverage found yet. Articles are indexed twice daily.

Related Legislation

Federal Bill

Reauthorization of the SOAR Health and Wellness Training Program

This bill extends federal funding for the 'Stop, Observe, Ask, and Respond' (SOAR) to Health and Wellness Training Program for an additional five year

Discoveries

Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.

policy shift90% confidence

Expansion of ACA Cost Protections

The bill extends the logic of out-of-pocket maximums specifically to prescription drugs, which are often subject to different cost-sharing rules than other medical services.

Patient Protection and Affordable Care Act

Connected Entities

personMs. Baldwin“Co-sponsor of the bill.”Map →

personMr. Van Hollen“Co-sponsor of the bill.”Map →

otherPatient Protection and Affordable Care Act“The Patient Protection and Affordable Care Act is the basis for this legislation”Map →

personMr. Welch“Co-sponsor of the bill.”Map →

otherSenate Committee on Health, Education, Labor, and Pensions“The committee to which the bill was referred.”Map →

personMr. Fetterman“Co-sponsor of the bill.”Map →

personMs. Klobuchar“Co-sponsor of the bill.”Map →

personMrs. Gillibrand“Co-sponsor of the bill.”Map →

personMr. Casey“Lead sponsor of the bill.”Map →

personMr. Warnock“Co-sponsor of the bill.”Map →

organizationBureau of Labor Statistics“Used to calculate adjustments to the cost-sharing caps.”Map →

personMr. Blumenthal“Co-sponsor of the bill.”Map →

organizationSenate“Introduced the bill.”Map →

otherPublic Health Service Act“Used to amend group health plan provisions.”Map →

Analysis Score

0–100

Significance85
How much this matters to a regular citizen
Controversy60
Intensity of disagreement among stakeholders
Entertainment10
Compellingness for a non-policy-wonk reader
Buzz40
Current news / social attention level