New Bill Caps Annual Prescription Drug Costs at $2,000 Starting in 2026

The Capping Prescription Costs Act of 2025 is straightforward: it puts a hard limit on how much you have to pay out-of-pocket for prescription drugs every year. Starting with plan years in 2026, if you’re on a qualified health plan—that means most plans purchased on the ACA marketplace or provided by your employer—your annual cost-sharing for medications cannot exceed $2,000 for an individual. For families, the cap is set at $4,000.

The Cap: Financial Security for High-Cost Meds

This isn't about your total healthcare spending; this cap applies only to prescription drug costs, like copays and deductibles related to your meds (Sec. 2). For anyone managing a chronic condition that requires expensive specialty drugs—think insulin, biologics for autoimmune disorders, or certain cancer treatments—this is a massive financial safety net. Currently, many plans require patients to meet high deductibles or pay significant co-insurance percentages on costly drugs, leading to thousands of dollars in bills before the plan kicks in fully. Under this bill, once you hit that $2,000 individual limit, your plan must cover 100% of the remaining drug costs for the rest of the year.

Who’s Covered and How It Changes

The beauty of this bill is its broad reach. It doesn't just target the ACA marketplace; it also amends the Public Health Service Act, ERISA, and the Internal Revenue Code to ensure that most employer-sponsored group health plans are also required to abide by these limits (Sec. 2). This means whether you work for a large corporation or buy coverage independently, your financial exposure to prescription drug costs is capped. For example, if you’re a software engineer whose employer-provided plan currently has a $5,000 drug deductible, that deductible must drop to $2,000 in 2026. This move provides predictability, which is gold when you’re budgeting.

Keeping Pace with Inflation (Mostly)

The bill acknowledges that costs rise, so the $2,000/$4,000 caps aren't static. For plan years starting after 2026, the limits will be adjusted based on the Consumer Price Index (CPI), which measures how much medical care costs generally increase (Sec. 2). There is one small detail to note: when calculating the annual increase, if the new number isn't a perfect multiple of $5, the adjustment is rounded down to the nearest lower multiple of $5. While this ensures the cap adjusts with inflation, the rounding down mechanism means the cap might lag slightly behind the true rate of medical inflation, though the difference would likely be negligible for most consumers.