Federal RuleAug 21
62
DOL Rewrites Disability Rules for 'Merit-Based Opportunity' Push
RuleLabor DepartmentFederal Contract Compliance Programs OfficeSignificant Wallet
119-hr-6166119th CongressWALLET
Lowering Drug Costs for American Families Act
Sponsored By: Representative Pallone, Frank [D-NJ-6]
Introduced
Summary
Expands federal drug price negotiation to 50 drugs while adding international price benchmarks and creating new national limits on prescription cost sharing, including a specific insulin cap and a standardized out-of-pocket framework.
Show full summary
- Families and people with coverage will see a new standardized essential health benefits and out-of-pocket framework that requires child-only coverage and ties future limits to an annual premium adjustment. These rules apply to plan years beginning January 1, 2027.
- People who use insulin must get at least one covered product for each insulin type and face cost sharing no greater than the lesser of $35 per 30-day supply or 25% of the negotiated price. Cost sharing under the cap counts toward deductibles and out-of-pocket maximums.
- Insurers, employers, and drugmakers face a bigger negotiation program that grows the pool from 20 to 50 drugs and requires the Secretary to consider an average international market price using six comparator countries. The bill also adds Part B and Part D style commercial-market inflation rebates and increased reporting requirements.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 2 benefits, 0 costs, 3 mixed.
Nationwide insulin cost cap
If enacted, many group and individual plans would have to cover selected insulin with no deductible and cap your cost for a 30-day supply. Your cost would be the lesser of $35 or 25% of the negotiated net price for a 30-day supply. Any payments you make under this cap would count toward your deductible and out-of-pocket maximum. Plans may exclude out-of-network insulin or charge more for it. This applies for plan years starting January 1, 2027.
New annual drug out-of-pocket limits
If enacted, individual and small-group plans (and many employer plans) would have new out-of-pocket rules starting for plan years on or after January 1, 2027. Prescription drug out-of-pocket limits would be $2,000 a year for self-only coverage and $4,000 for other-than-self-only coverage in 2027. These limits count deductibles, coinsurance, and copays, and they rise each year by a premium adjustment percentage. The bill would also stop the old PHSA cost-sharing rules for plan years beginning January 1, 2027.
Extend drug negotiation to private plans
If enacted, private group health plans and many individual market plans could be treated as having drug-price agreements when they cover a selected drug. Plans could opt out through a Secretary-specified process. When a plan is treated as having an agreement, the same program rules would apply and the plan must use the negotiated maximum fair price when figuring your cost-sharing. The government would publish which plans and issuers chose not to participate for each drug and price period.
Bigger negotiation pool and benchmarks
If enacted, the Drug Price Negotiation Program could select up to 50 drugs instead of 20. For negotiations starting January 1, 2028, the Secretary would have to consider the average price of the drug in Australia, Canada, France, Germany, Japan, and the United Kingdom. The bill would also repeal a recent statutory change so earlier law is restored for the program.
Change drug rebate and unit reporting
If enacted, Medicare Part B rebate rules would count 'billing units' instead of raw units and use reported data from two quarters earlier, excluding Medicaid-paid units. Part D rebate rules would use units reported for Average Manufacturer Price (AMP), exclude Medicaid and Part B rebate units, and, starting with plan year 2026, exclude units with 340B discounts. The bill also requires AMP reporting methods for manufacturers.
Sponsors & CoSponsors
Sponsor
Pallone, Frank [D-NJ-6]
NJ • D
Cosponsors
Rep. Balint, Becca [D-VT-At Large]
VT • D
Sponsored 10/26/2026
Rep. Hoyle, Val T. [D-OR-4]
OR • D
Sponsored 10/26/2026
Rep. Neal, Richard E. [D-MA-1]
MA • D
Sponsored 11/20/2025
Rep. Scott, Robert C. "Bobby" [D-VA-3]
VA • D
Sponsored 11/20/2025
Rep. Tonko, Paul [D-NY-20]
NY • D
Sponsored 11/21/2025
Rep. McClellan, Jennifer L. [D-VA-4]
VA • D
Sponsored 11/21/2025
Rep. Beatty, Joyce [D-OH-3]
OH • D
Sponsored 11/21/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 11/21/2025
Rep. Landsman, Greg [D-OH-1]
OH • D
Sponsored 11/21/2025
Rep. Mannion, John W. [D-NY-22]
NY • D
Sponsored 11/21/2025
Rep. Craig, Angie [D-MN-2]
MN • D
Sponsored 11/21/2025
Rep. Frankel, Lois [D-FL-22]
FL • D
Sponsored 11/21/2025
Rep. Matsui, Doris O. [D-CA-7]
CA • D
Sponsored 11/21/2025
Rep. Dingell, Debbie [D-MI-6]
MI • D
Sponsored 11/21/2025
Rep. Wasserman Schultz, Debbie [D-FL-25]
FL • D
Sponsored 11/21/2025
Rep. Thanedar, Shri [D-MI-13]
MI • D
Sponsored 11/21/2025
Rep. Goldman, Daniel S. [D-NY-10]
NY • D
Sponsored 11/21/2025
Rep. Larson, John B. [D-CT-1]
CT • D
Sponsored 12/1/2025
Rep. Hoyer, Steny H. [D-MD-5]
MD • D
Sponsored 12/1/2025
Rep. Johnson, Julie [D-TX-32]
TX • D
Sponsored 12/1/2025
Rep. Simon, Lateefah [D-CA-12]
CA • D
Sponsored 12/1/2025
Rep. Riley, Josh [D-NY-19]
NY • D
Sponsored 12/1/2025
Rep. Costa, Jim [D-CA-21]
CA • D
Sponsored 12/1/2025
Rep. Clarke, Yvette D. [D-NY-9]
NY • D
Sponsored 12/1/2025
Rep. Chu, Judy [D-CA-28]
CA • D
Sponsored 12/1/2025
Rep. Underwood, Lauren [D-IL-14]
IL • D
Sponsored 12/1/2025
Rep. Dexter, Maxine [D-OR-3]
OR • D
Sponsored 12/1/2025
Rep. Courtney, Joe [D-CT-2]
CT • D
Sponsored 12/1/2025
Rep. McIver, LaMonica [D-NJ-10]
NJ • D
Sponsored 12/1/2025
Rep. Gillen, Laura [D-NY-4]
NY • D
Sponsored 12/1/2025
Rep. Schakowsky, Janice D. [D-IL-9]
IL • D
Sponsored 12/1/2025
Rep. Quigley, Mike [D-IL-5]
IL • D
Sponsored 12/2/2025
Rep. Omar, Ilhan [D-MN-5]
MN • D
Sponsored 12/2/2025
Rep. Deluzio, Christopher R. [D-PA-17]
PA • D
Sponsored 12/3/2025
Rep. Bonamici, Suzanne [D-OR-1]
OR • D
Sponsored 12/3/2025
Rep. Fletcher, Lizzie [D-TX-7]
TX • D
Sponsored 12/5/2025
Rep. Carson, André [D-IN-7]
IN • D
Sponsored 12/9/2025
Rep. Garcia, Robert [D-CA-42]
CA • D
Sponsored 12/10/2025
Rep. Stansbury, Melanie A. [D-NM-1]
NM • D
Sponsored 12/10/2025
Rep. Grijalva, Adelita S. [D-AZ-7]
AZ • D
Sponsored 12/17/2025
Rep. Lieu, Ted [D-CA-36]
CA • D
Sponsored 12/17/2025
Rep. Ansari, Yassamin [D-AZ-3]
AZ • D
Sponsored 12/17/2025
Rep. Davids, Sharice [D-KS-3]
KS • D
Sponsored 12/17/2025
Rep. Randall, Emily [D-WA-6]
WA • D
Sponsored 12/17/2025
Rep. DelBene, Suzan K. [D-WA-1]
WA • D
Sponsored 12/18/2025
Rep. Waters, Maxine [D-CA-43]
CA • D
Sponsored 12/18/2025
Rep. Krishnamoorthi, Raja [D-IL-8]
IL • D
Sponsored 12/18/2025
Rep. Friedman, Laura [D-CA-30]
CA • D
Sponsored 1/21/2026
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 2/4/2026
Rep. Vindman, Eugene Simon [D-VA-7]
VA • D
Sponsored 2/9/2026
Rep. McClain Delaney, April [D-MD-6]
MD • D
Sponsored 2/12/2026
Rep. Budzinski, Nikki [D-IL-13]
IL • D
Sponsored 4/2/2026
Rep. Jackson, Jonathan L. [D-IL-1]
IL • D
Sponsored 4/14/2026
Rep. Titus, Dina [D-NV-1]
NV • D
Sponsored 4/14/2026
Rep. Hayes, Jahana [D-CT-5]
CT • D
Sponsored 4/20/2026
Rep. DeSaulnier, Mark [D-CA-10]
CA • D
Sponsored 4/27/2026
Rep. Stevens, Haley M. [D-MI-11]
MI • D
Sponsored 6/4/2026
Rep. Frost, Maxwell [D-FL-10]
FL • D
Sponsored 7/23/2026
Rep. Pingree, Chellie [D-ME-1]
ME • D
Sponsored 8/24/2026
Rep. Wilson, Frederica S. [D-FL-24]
FL • D
Sponsored 8/24/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov