Bill > S529

This bill aims to limit out-of-pocket prescription drug costs for individuals and families by establishing annual caps on cost-sharing for health plans. Specifically, the bill amends the Patient Protection and Affordable Care Act (ACA) to set a maximum annual out-of-pocket expense for prescription drugs at $2,000 per individual and $4,000 per family starting in 2026. The cost limit will be adjusted annually based on the medical care component of the consumer price index, with any increases rounded to the nearest $5. The bill applies these cost-sharing restrictions to qualified health plans, group health plans, and health insurance issuers, ensuring that insurance plans across different sectors are subject to the same prescription drug cost limitations. The changes will take effect for plan years beginning on or after January 1, 2026, giving health insurers and providers time to adapt to the new requirements. By implementing these caps, the bill seeks to make prescription medications more affordable and predictable for consumers, potentially reducing the financial burden of healthcare expenses.

Health and Social Services

https://www.congress.gov/bill/119th-congress/senate-bill/529/all-info