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HR6171119th CongressWALLET
ACA Copay CAP Act of 2025
Sponsored By: Representative Auchincloss, Jake [D-MA-4]
Introduced
Summary
Creates a nationwide annual out-of-pocket cap on prescription drug cost-sharing for individual and group health plans. The cap starts for plan years beginning on or after January 1, 2027 and sets a 2027 base amount that is indexed in later years.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Caps yearly out-of-pocket drug costs
Starting with plan years that begin on or after January 1, 2027, this bill would cap what you pay out of pocket for prescription drugs. In 2027, the cap would be $2,000 for self-only coverage and $4,000 for family or other coverage. For plan years that begin in 2028 and later, the cap would rise each year by the premium adjustment percentage, with any increase rounded down to the next $50. The cap would apply to drugs filled during that plan year. If you reach the cap, your plan would treat you as having met the rule for drug benefits for the rest of the year. Other medical costs would still follow existing ACA rules.
Sponsors & CoSponsors
Sponsor
Auchincloss, Jake [D-MA-4]
MA • D
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov