Capping Prescription Costs Act of 2025
Sponsored By: Senator Raphael Warnock
Introduced
Summary
Nationwide caps on prescription drug cost-sharing would limit annual out-of-pocket drug payments for people with private coverage. The bill would cap costs at $2,000 per person or $4,000 per family in 2026 and then adjust the cap for inflation starting in 2027.
Show full summary
- Families and individuals: People with employer or individual plans would face a maximum annual drug cost-sharing of $2,000 per person or $4,000 per family starting in plan years 2026. Caps would rise each year using the medical care Consumer Price Index for All Urban Consumers and would be rounded down to the nearest $5 when needed.
- Employers and group plans: Group health plans must follow the same cap because the bill adds matching provisions to the Employee Retirement Income Security Act and the Internal Revenue Code. The requirement applies to plan years beginning on or after January 1, 2026.
- Insurers and markets: Health insurance issuers offering individual and group coverage must apply the cap under the Public Health Service Act, creating a uniform rule across markets. The annual adjustment uses the CPI-U medical care component to update the cap from 2027 onward.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Cap prescription drug costs for families
If enacted, this would limit how much you pay each year for prescription drug cost-sharing. For plan years beginning January 1, 2026, the cap would be $2,000 per enrolled individual and $4,000 per family. For plan years after 2026, the cap would rise each year by the CPI‑U medical care percentage, with any increase rounded down to the nearest $5. The rule would apply across individual and employer (group) health plans by adding matching requirements to the Public Health Service Act, ERISA, and the Internal Revenue Code.
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Sponsors & CoSponsors
Sponsor
Raphael Warnock
GA • D
Cosponsors
Sen. Baldwin, Tammy [D-WI]
WI • D
Sponsored 2/11/2025
Sen. Booker, Cory A. [D-NJ]
NJ • D
Sponsored 2/11/2025
Richard Blumenthal
CT • D
Sponsored 2/11/2025
Sen. Fetterman, John [D-PA]
PA • D
Sponsored 2/11/2025
Kirsten Gillibrand
NY • D
Sponsored 2/11/2025
Sen. Heinrich, Martin [D-NM]
NM • D
Sponsored 2/11/2025
Andy Kim
NJ • D
Sponsored 2/11/2025
Amy Klobuchar
MN • D
Sponsored 2/11/2025
Sen. Murray, Patty [D-WA]
WA • D
Sponsored 2/11/2025
Peter Welch
VT • D
Sponsored 2/11/2025
Sen. Alsobrooks, Angela D. [D-MD]
MD • D
Sponsored 4/1/2025
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 4/1/2025
Sen. Gallego, Ruben [D-AZ]
AZ • D
Sponsored 8/1/2025
Roll Call Votes
No roll call votes available for this bill.
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