New ACA Cap Sets $2,000 Annual Limit on Prescription Drug Costs Starting in 2027

The new ACA Copay CAP Act of 2025 is aiming to hit the reset button on prescription drug costs for millions of Americans. Starting in 2027, this legislation establishes a hard annual cap on how much money individuals and families have to pay out-of-pocket for their medications.

The New Bottom Line for Your Pharmacy Bill

This bill amends the Affordable Care Act (ACA) to create a separate annual cost-sharing limit specifically for prescription drugs. For anyone with self-only coverage, the cap starts at $2,000 for the 2027 plan year. If you have family or other non-self-only coverage, that limit is set at twice that amount, or $4,000. Think of it as a financial safety net for your medicine cabinet. Once your total copays and deductibles for drugs hit that $2,000 or $4,000 mark, your insurance plan has to cover 100% of your remaining prescription drug costs for the rest of the year (Sec. 1302(e)(1)(B)(i)).

Who This Helps (And Why It Matters to Your Budget)

This cap is a huge deal for anyone managing a chronic condition that requires expensive, specialty, or brand-name drugs. Right now, you might hit your general deductible and then still face high copays until you reach your overall out-of-pocket maximum—which can be $9,100 for an individual in 2024. For someone with multiple sclerosis or severe rheumatoid arthritis, where a single monthly injection can cost thousands, hitting the $2,000 drug cap early in the year means instant relief and predictability. Instead of budgeting for five figures in potential drug costs, you know your absolute maximum is capped at two grand.

The Inflation Factor: Small Print Details

To keep pace with rising costs, the $2,000 cap will be adjusted annually starting in 2028 based on the “premium adjustment percentage.” However, there’s a small detail in the fine print: any increase that isn’t a multiple of $50 will be rounded down to the next lowest multiple of $50. For example, if the calculation suggests the cap should be $2,045, it would be rounded down to $2,000. If it hits $2,070, it rounds down to $2,050. This rounding mechanism means the cap might increase slightly slower than true drug inflation over time, which is something to watch, but the initial protection remains substantial.

Shifting the Burden

While this is a clear win for consumers—especially those with high medical needs—it doesn’t eliminate the cost; it just shifts it. The financial burden for those high-cost patients moves squarely onto the health insurance providers, who are now fully responsible for drug costs above the $2,000 limit. This could put pressure on insurers to negotiate harder with pharmaceutical companies to lower net prices, or, potentially, it could contribute to slight increases in overall plan premiums down the road to compensate for the new liability. For now, though, the immediate, tangible benefit is the financial predictability and protection this cap offers to patients.