Us Congress 2025-2026 Regular Session

Us Congress Senate Bill SB529 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	II
2	2	119THCONGRESS
3	3	1
4	4	STSESSION S. 529
5	5	To limit cost-sharing for prescription drugs, and for other purposes.
6	6	IN THE SENATE OF THE UNITED STATES
7	7	FEBRUARY11, 2025
8	8	Mr. W
9	9	ARNOCK(for himself, Ms. BALDWIN, Mr. BOOKER, Mr. BLUMENTHAL,
10	10	Mr. F
11	11	ETTERMAN, Mrs. GILLIBRAND, Mr. HEINRICH, Mr. KIM, Ms. KLO-
12	12	BUCHAR, Mrs. MURRAY, and Mr. WELCH) introduced the following bill;
13	13	which was read twice and referred to the Committee on Health, Edu-
14	14	cation, Labor, and Pensions
15	15	A BILL
16	16	To limit cost-sharing for prescription drugs, and for other
17	17	purposes.
18	18	Be it enacted by the Senate and House of Representa-1
19	19	tives of the United States of America in Congress assembled, 2
20	20	SECTION 1. SHORT TITLE. 3
21	21	This Act may be cited as the ‘‘Capping Prescription 4
22	22	Costs Act of 2025’’. 5
23	23	SEC. 2. CAP ON PRESCRIPTION DRUG COST-SHARING. 6
24	24	(a) Q
25	25	UALIFIEDHEALTHPLANS.—Section 1302(c) of 7
26	26	the Patient Protection and Affordable Care Act (42 8
27	27	U.S.C. 18022(c)) is amended— 9
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30	30	•S 529 IS
31	31	(1) in paragraph (3)(A)(i), by inserting ‘‘, in-1
32	32	cluding cost-sharing with respect to prescription 2
33	33	drugs covered by the plan’’ after ‘‘charges’’; and 3
34	34	(2) by adding at the end the following: 4
35	35	‘‘(5) P
36	36	RESCRIPTION DRUG COST -SHARING.— 5
37	37	‘‘(A) 2026.—For plan years beginning in 6
38	38	2026, the cost-sharing incurred under a health 7
39	39	plan with respect to prescription drugs covered 8
40	40	by the plan shall not exceed $2,000 per year for 9
41	41	each enrolled individual, or $4,000 per year for 10
42	42	each family. 11
43	43	‘‘(B) 2027
44	44	AND LATER.— 12
45	45	‘‘(i) I
46	46	N GENERAL.—In the case of any 13
47	47	plan year beginning in a calendar year 14
48	48	after 2026, the limitation under this para-15
49	49	graph shall be equal to the applicable dol-16
50	50	lar amount under subparagraph (A) for 17
51	51	plan years beginning in 2026, increased by 18
52	52	an amount equal to the product of that 19
53	53	amount and the medical care component of 20
54	54	the consumer price index for all urban con-21
55	55	sumers (as published by the Bureau of 22
56	56	Labor Statistics) for that year. 23
57	57	‘‘(ii) A
58	58	DJUSTMENT TO AMOUNT .—If 24
59	59	the amount of any increase under clause 25
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62	62	•S 529 IS
63	63	(i) is not a multiple of $5, such increase 1
64	64	shall be rounded to the next lowest mul-2
65	65	tiple of $5.’’. 3
66	66	(b) G
67	67	ROUPHEALTHPLANS.— 4
68	68	(1) P
69	69	UBLIC HEALTH SERVICE ACT .—Part D of 5
70	70	title XXVII of the Public Health Service Act (42 6
71	71	U.S.C. 300gg–111 et seq.) is amended by inserting 7
72	72	after section 2799A–5 (42 U.S.C. 300gg–115) the 8
73	73	following: 9
74	74	‘‘SEC. 2799A–6. CAP ON PRESCRIPTION DRUG COST-SHAR-10
75	75	ING FOR GROUP HEALTH PLANS. 11
76	76	‘‘A group health plan and health insurance issuer of-12
77	77	fering group health insurance coverage shall ensure that 13
78	78	any cost-sharing imposed under the plan or coverage with 14
79	79	respect to prescription drugs covered by the plan or cov-15
80	80	erage does not exceed the limitations provided for under 16
81	81	paragraph (5) of section 1302(c) of the Patient Protection 17
82	82	and Affordable Care Act.’’. 18
83	83	(2) E
84	84	MPLOYEE RETIREMENT INCOME SECURITY 19
85	85	ACT.— 20
86	86	(A) I
87	87	N GENERAL.—Subpart B of part 7 of 21
88	88	subtitle B of title I of the Employee Retirement 22
89	89	Income Security Act (29 U.S.C. 1185 et seq.) 23
90	90	is amended by inserting after section 720 (29 24
91	91	U.S.C. 1185i) the following: 25
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94	94	•S 529 IS
95	95	‘‘SEC. 721. CAP ON PRESCRIPTION DRUG COST-SHARING. 1
96	96	‘‘A group health plan and health insurance issuer of-2
97	97	fering group health insurance coverage shall ensure that 3
98	98	any cost-sharing imposed under the plan or coverage with 4
99	99	respect to prescription drugs covered by the plan or cov-5
100	100	erage does not exceed the limitations provided for under 6
101	101	paragraph (5) of section 1302(c) of the Patient Protection 7
102	102	and Affordable Care Act.’’. 8
103	103	(B) C
104	104	LERICAL AMENDMENT .—The table of 9
105	105	contents in section 1 of the Employee Retire-10
106	106	ment Income Security Act of 1974 (29 U.S.C. 11
107	107	1001 note) is amended by inserting after the 12
108	108	item relating to section 720 the following: 13
109	109	‘‘Sec. 721. Cap on prescription drug cost-sharing’’.
110	110	(3) INTERNAL REVENUE CODE OF 1986 .— 14
111	111	(A) I
112	112	N GENERAL.—Subchapter B of chap-15
113	113	ter 100 of the Internal Revenue Code of 1986 16
114	114	is amended by inserting after section 9820 the 17
115	115	following: 18
116	116	‘‘SEC. 9821. CAP ON PRESCRIPTION DRUG COST-SHARING. 19
117	117	‘‘A group health plan shall ensure that any cost-shar-20
118	118	ing imposed under the plan with respect to prescription 21
119	119	drugs covered by the plan does not exceed the limitations 22
120	120	provided for under paragraph (5) of section 1302(c) of 23
121	121	the Patient Protection and Affordable Care Act.’’. 24
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124	124	•S 529 IS
125	125	(B) CLERICAL AMENDMENT .—The table of 1
126	126	sections for subchapter B of chapter 100 of the 2
127	127	Internal Revenue Code of 1986 is amended by 3
128	128	inserting after the item relating to section 9820 4
129	129	the following: 5
130	130	‘‘Sec. 9821. Cap on prescription drug cost-sharing’’.
131	131	(c) EFFECTIVEDATE.—The amendments made by 6
132	132	subsections (a) and (b) shall take effect with respect to 7
133	133	plan years beginning on or after January 1, 2026. 8
134	134	Æ
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