[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2553 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 2553
To limit cost-sharing for prescription drugs, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 1, 2025
Mr. Horsford (for himself, Mr. Figures, Ms. Stansbury, Mr. Johnson of
Georgia, Ms. Waters, Mrs. Cherfilus-McCormick, Mrs. Hayes, Mr. Thompson
of Mississippi, and Ms. Norton) introduced the following bill; which
was referred to the Committee on Energy and Commerce, and in addition
to the Committees on Education and Workforce, and Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
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A BILL
To limit cost-sharing for prescription drugs, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Capping Prescription Costs Act of
2025''.
SEC. 2. CAP ON PRESCRIPTION DRUG COST-SHARING.
(a) Qualified Health Plans.--Section 1302(c) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18022(c)) is amended--
(1) in paragraph (3)(A)(i), by inserting ``, including
cost-sharing with respect to prescription drugs covered by the
plan'' after ``charges''; and
(2) by adding at the end the following:
``(5) Prescription drug cost-sharing.--
``(A) 2026.--For plan years beginning in 2026, the
cost-sharing incurred under a health plan with respect
to prescription drugs covered by the plan shall not
exceed $2,000 per year for each enrolled individual, or
$4,000 per year for each family.
``(B) 2027 and later.--
``(i) In general.--In the case of any plan
year beginning in a calendar year after 2026,
the limitation under this paragraph shall be
equal to the applicable dollar amount under
subparagraph (A) for plan years beginning in
2026, increased by an amount equal to the
product of that amount and the medical care
component of the consumer price index for all
urban consumers (as published by the Bureau of
Labor Statistics) for that year.
``(ii) Adjustment to amount.--If the amount
of any increase under clause (i) is not a
multiple of $5, such increase shall be rounded
to the next lowest multiple of $5.''.
(b) Group Health Plans.--
(1) Public health service act.--Part D of title XXVII of
the Public Health Service Act (42 U.S.C. 300gg-111 et seq.) is
amended by inserting after section 2799A-5 (42 U.S.C. 300gg-
115) the following:
``SEC. 2799A-6. CAP ON PRESCRIPTION DRUG COST-SHARING FOR GROUP HEALTH
PLANS.
``A group health plan and health insurance issuer offering group
health insurance coverage shall ensure that any cost-sharing imposed
under the plan or coverage with respect to prescription drugs covered
by the plan or coverage does not exceed the limitations provided for
under paragraph (5) of section 1302(c) of the Patient Protection and
Affordable Care Act.''.
(2) Employee retirement income security act.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
inserting after section 720 (29 U.S.C. 1185i) the
following:
``SEC. 721. CAP ON PRESCRIPTION DRUG COST-SHARING.
``A group health plan and health insurance issuer offering group
health insurance coverage shall ensure that any cost-sharing imposed
under the plan or coverage with respect to prescription drugs covered
by the plan or coverage does not exceed the limitations provided for
under paragraph (5) of section 1302(c) of the Patient Protection and
Affordable Care Act.''.
(B) Clerical amendment.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1001 note) is amended by
inserting after the item relating to section 720 the
following:
``Sec. 721. Cap on prescription drug cost-sharing.''.
(3) Internal revenue code of 1986.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by inserting
after section 9820 the following:
``SEC. 9821. CAP ON PRESCRIPTION DRUG COST-SHARING.
``A group health plan shall ensure that any cost-sharing imposed
under the plan with respect to prescription drugs covered by the plan
does not exceed the limitations provided for under paragraph (5) of
section 1302(c) of the Patient Protection and Affordable Care Act.''.
(B) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended by inserting after the item
relating to section 9820 the following:
``Sec. 9821. Cap on prescription drug cost-sharing''.
(c) Effective Date.--The amendments made by subsections (a) and (b)
shall take effect with respect to plan years beginning on or after
January 1, 2026.
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