II
119THCONGRESS
1
STSESSION S. 529
To limit cost-sharing for prescription drugs, and for other purposes.
IN THE SENATE OF THE UNITED STATES
FEBRUARY11, 2025
Mr. W
ARNOCK(for himself, Ms. BALDWIN, Mr. BOOKER, Mr. BLUMENTHAL,
Mr. F
ETTERMAN, Mrs. GILLIBRAND, Mr. HEINRICH, Mr. KIM, Ms. KLO-
BUCHAR, Mrs. MURRAY, and Mr. WELCH) introduced the following bill;
which was read twice and referred to the Committee on Health, Edu-
cation, Labor, and Pensions
A BILL
To limit cost-sharing for prescription drugs, and for other
purposes.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Capping Prescription 4
Costs Act of 2025’’. 5
SEC. 2. CAP ON PRESCRIPTION DRUG COST-SHARING. 6
(a) Q
UALIFIEDHEALTHPLANS.—Section 1302(c) of 7
the Patient Protection and Affordable Care Act (42 8
U.S.C. 18022(c)) is amended— 9
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•S 529 IS
(1) in paragraph (3)(A)(i), by inserting ‘‘, in-1
cluding cost-sharing with respect to prescription 2
drugs covered by the plan’’ after ‘‘charges’’; and 3
(2) by adding at the end the following: 4
‘‘(5) P
RESCRIPTION DRUG COST -SHARING.— 5
‘‘(A) 2026.—For plan years beginning in 6
2026, the cost-sharing incurred under a health 7
plan with respect to prescription drugs covered 8
by the plan shall not exceed $2,000 per year for 9
each enrolled individual, or $4,000 per year for 10
each family. 11
‘‘(B) 2027
AND LATER.— 12
‘‘(i) I
N GENERAL.—In the case of any 13
plan year beginning in a calendar year 14
after 2026, the limitation under this para-15
graph shall be equal to the applicable dol-16
lar amount under subparagraph (A) for 17
plan years beginning in 2026, increased by 18
an amount equal to the product of that 19
amount and the medical care component of 20
the consumer price index for all urban con-21
sumers (as published by the Bureau of 22
Labor Statistics) for that year. 23
‘‘(ii) A
DJUSTMENT TO AMOUNT .—If 24
the amount of any increase under clause 25
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•S 529 IS
(i) is not a multiple of $5, such increase 1
shall be rounded to the next lowest mul-2
tiple of $5.’’. 3
(b) G
ROUPHEALTHPLANS.— 4
(1) P
UBLIC HEALTH SERVICE ACT .—Part D of 5
title XXVII of the Public Health Service Act (42 6
U.S.C. 300gg–111 et seq.) is amended by inserting 7
after section 2799A–5 (42 U.S.C. 300gg–115) the 8
following: 9
‘‘SEC. 2799A–6. CAP ON PRESCRIPTION DRUG COST-SHAR-10
ING FOR GROUP HEALTH PLANS. 11
‘‘A group health plan and health insurance issuer of-12
fering group health insurance coverage shall ensure that 13
any cost-sharing imposed under the plan or coverage with 14
respect to prescription drugs covered by the plan or cov-15
erage does not exceed the limitations provided for under 16
paragraph (5) of section 1302(c) of the Patient Protection 17
and Affordable Care Act.’’. 18
(2) E
MPLOYEE RETIREMENT INCOME SECURITY 19
ACT.— 20
(A) I
N GENERAL.—Subpart B of part 7 of 21
subtitle B of title I of the Employee Retirement 22
Income Security Act (29 U.S.C. 1185 et seq.) 23
is amended by inserting after section 720 (29 24
U.S.C. 1185i) the following: 25
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‘‘SEC. 721. CAP ON PRESCRIPTION DRUG COST-SHARING. 1
‘‘A group health plan and health insurance issuer of-2
fering group health insurance coverage shall ensure that 3
any cost-sharing imposed under the plan or coverage with 4
respect to prescription drugs covered by the plan or cov-5
erage does not exceed the limitations provided for under 6
paragraph (5) of section 1302(c) of the Patient Protection 7
and Affordable Care Act.’’. 8
(B) C
LERICAL AMENDMENT .—The table of 9
contents in section 1 of the Employee Retire-10
ment Income Security Act of 1974 (29 U.S.C. 11
1001 note) is amended by inserting after the 12
item relating to section 720 the following: 13
‘‘Sec. 721. Cap on prescription drug cost-sharing’’.
(3) INTERNAL REVENUE CODE OF 1986 .— 14
(A) I
N GENERAL.—Subchapter B of chap-15
ter 100 of the Internal Revenue Code of 1986 16
is amended by inserting after section 9820 the 17
following: 18
‘‘SEC. 9821. CAP ON PRESCRIPTION DRUG COST-SHARING. 19
‘‘A group health plan shall ensure that any cost-shar-20
ing imposed under the plan with respect to prescription 21
drugs covered by the plan does not exceed the limitations 22
provided for under paragraph (5) of section 1302(c) of 23
the Patient Protection and Affordable Care Act.’’. 24
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(B) CLERICAL AMENDMENT .—The table of 1
sections for subchapter B of chapter 100 of the 2
Internal Revenue Code of 1986 is amended by 3
inserting after the item relating to section 9820 4
the following: 5
‘‘Sec. 9821. Cap on prescription drug cost-sharing’’.
(c) EFFECTIVEDATE.—The amendments made by 6
subsections (a) and (b) shall take effect with respect to 7
plan years beginning on or after January 1, 2026. 8
Æ
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