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HR10133119th CongressWALLET

Fair Prescription Pricing Act of 2026

Sponsored By: Representative Scholten, Hillary J. [D-MI-3]

Introduced

Summary

This bill would create a uniform national cap on what patients pay for prescription drugs by tying out-of-pocket limits to a rolling, SSA-based average price. It focuses on limiting cost sharing for covered outpatient drugs dispensed at in-network pharmacies and uses Social Security Act survey data to set the cap for each plan year.

Show full summary
  • Families and patients: Lowers or limits out-of-pocket costs for covered outpatient drugs at in-network pharmacies by capping patient cost sharing at the nationwide average consumer purchase price for each drug based on the 1-year SSA survey window.
  • Employers and workers in group plans: Would require group health plans and group coverage to apply the same cap for plan years starting after enactment, changing how employer-sponsored benefits calculate drug cost sharing.
  • Plans, issuers, PBMs, and pharmacies: Requires health plans and issuers to ensure pharmacy benefit managers (PBMs) follow the same cap and defines covered outpatient drugs and in-network pharmacies using Social Security Act terms.

*No federal cost estimate is provided in the sources, so this summary does not project budget effects.*

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Bill Overview

Analyzed Economic Effects

1 provisions identified: 1 benefits, 0 costs, 0 mixed.

Cap on prescription drug cost-sharing

This bill would stop group and individual health plans from charging more than the nationwide average purchase price when you fill a covered outpatient drug at an in-network pharmacy. The cap would equal the drug's nationwide average price for the 1-year period ending on the first day of the plan year, using the SSA survey data in section 1927(f)(1)(A)(i). Plans and issuers would have to ensure any pharmacy benefit manager they hire follows the same limit. The rule would apply to drugs defined as "covered outpatient drug" in SSA section 1927(k) and to pharmacies that have a contractual relationship with the plan. It would take effect for plan years beginning on or after the date of enactment.

Sponsors & CoSponsors

Sponsor

Scholten, Hillary J. [D-MI-3]

MI • D

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

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