[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6171 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 6171
To amend the Patient Protection and Affordable Care Act to establish an
out-of-pocket limit on spending for prescription drugs.
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IN THE HOUSE OF REPRESENTATIVES
November 20, 2025
Mr. Auchincloss introduced the following bill; which was referred to
the Committee on Energy and Commerce
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A BILL
To amend the Patient Protection and Affordable Care Act to establish an
out-of-pocket limit on spending for prescription drugs.
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 ``ACA Copay Cost and Affordability for
Patients Act of 2025'' or the ``ACA Copay CAP Act of 2025''.
SEC. 2. ESTABLISHING AN OUT-OF-POCKET LIMIT ON SPENDING FOR
PRESCRIPTION DRUGS.
(a) In General.--Section 1302(c) of the Patient Protection and
Affordable Care Act (42 U.S.C. 18022(c)) is amended--
(1) by inserting after paragraph (1) the following new
paragraph:
``(2) Annual limitation on cost-sharing for drugs.--
``(A) In general.--The annual cost-sharing incurred
under a health plan with respect to prescription drugs
dispensed during a plan year beginning on or after
January 1, 2027, shall not exceed the dollar amount
specified in subparagraph (B) with respect to such plan
year.
``(B) Amount specified.--For purposes of
subparagraph (B), the dollar amount specified in this
subparagraph with respect to a plan year is the
following:
``(i) With respect to self-only coverage--
``(I) for plan years beginning in
2027, $2,000; and
``(II) for plan years beginning in
2028 or a subsequent year, the dollar
amount in effect under this
subparagraph for plan years beginning
in 2027, increased by an amount equal
to the product of that amount and the
premium adjustment percentage under
paragraph (4) for the calendar year.
``(ii) With respect to coverage other than
self-only coverage, for plan years beginning in
2027 or a subsequent calendar year, twice the
amount in effect under clause (i) for such plan
year.
If the amount of any increase under clause (i) is not a
multiple of $50, such increase shall be rounded to the
next lowest multiple of $50.''; and
(2) in paragraph (4)--
(A) by striking ``paragraph (1)(B)(i)'' and
inserting ``paragraphs (1) and (2)''; and
(B) by striking ``(as determined by the
Secretary)'' and inserting ``(or, for purposes of
paragraph (2), for 2027), as determined by the
Secretary''.
(b) Conforming Amendments.--
(1) PPACA.--Section 1302(e)(1)(B)(i) of the Patient
Protection and Affordable Care Act (42 U.S.C.
18022(e)(1)(B)(i)) is amended by inserting ``and except, with
respect to plan years beginning on or after January 1, 2027, in
the case of an individual who has incurred cost-sharing
expenses with respect to prescription drugs in an amount equal
to the limitation in effect under subsection (c)(2) for such
plan year, for benefits consisting of prescription drugs''
after ``section 2713''.
(2) PHSA.--Section 2707(b) of the Public Health Service Act
(42 U.S.C. 300gg-6(b)) is amended by inserting ``or (2)'' after
``paragraph (1)''.
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