The "Capping Prescription Costs Act of 2025" caps annual out-of-pocket prescription drug costs at $2,000 for individuals and $4,000 for families under qualified health plans starting in 2026, with future adjustments for inflation.
Raphael Warnock
Senator
GA
The "Capping Prescription Costs Act of 2025" aims to lower prescription drug costs by setting annual cost-sharing limits. Starting in 2026, individual out-of-pocket expenses for prescription drugs will be capped at $2,000, and family expenses at $4,000 under qualified health plans. These limits will be adjusted annually based on the consumer price index. The act also ensures that group health plans adhere to cost-sharing limits set by the Affordable Care Act.
New Bill Caps Annual Prescription Drug Costs at $2,000, Starting 2026
The Capping Prescription Costs Act of 2025 is all about lowering what you pay out-of-pocket for your meds. Starting January 1, 2026, this bill puts a hard limit on how much you'll shell out each year for prescription drugs under qualified health plans.
Prescription Price Relief
This bill directly tackles the rising costs of prescription drugs. Here’s the core of it: starting in 2026, your out-of-pocket costs for prescriptions are capped at $2,000 per year if you're single, and $4,000 per year for families (SEC. 2). That means, no matter how expensive your meds get, you won't pay more than these amounts in a given year, at least, for the portion that is usually considered cost-sharing. After 2026, these caps will be adjusted based on the medical care component of the consumer price index, rounded down to the nearest $5. This means that the cap will likely increase over time, but it will be tied to the general increase in healthcare costs.
For example, imagine a construction worker who relies on several expensive medications to manage a chronic condition. Before this bill, their annual prescription costs might have been, say $6,000. Under this new law, their costs would be capped at $2,000, saving them a significant $4,000 per year. Or consider a freelance graphic designer with a family plan. If their family's total prescription drug expenses reached $8,000, they'd now only be responsible for $4,000.
Sticking to the Standards
This bill also makes sure that group health plans and health insurance issuers stick to the cost-sharing limits already set by the Patient Protection and Affordable Care Act (ACA). This part reinforces existing rules, ensuring these plans don’t try to sneak in higher costs (SEC. 2).
While this should help keep more money in your pocket, there's always the chance that insurance companies might try to bump up premiums or deductibles to make up for the lost revenue. It's also possible that pharmaceutical companies could raise drug prices to offset the limits, which could water down the benefits over the long haul. It's something to keep an eye on as the bill rolls out.