Capping Prescription Costs Act of 2025
- Bill Number
- H.R. 2553
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-04-01: 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.
- Last Updated
- 2026-03-13T08:05:35Z
AI-Generated Summary
Capping Prescription Costs Act of 2025 (H.R. 2553)
Purpose
The legislation aims to reduce the financial burden on individuals and families by capping out-of-pocket costs (known as cost-sharing) for prescription drugs under certain health insurance plans. This includes plans offered through the Affordable Care Act (ACA) marketplaces and employer-sponsored group health plans.
Key Provisions
- Cap for Qualified Health Plans (ACA Marketplace Plans): Starting in 2026, annual cost-sharing for covered prescription drugs is limited to $2,000 per individual or $4,000 per family. This cap applies in addition to existing overall out-of-pocket limits.
- Annual Adjustments: For 2027 and later years, the cap increases based on the medical care component of the Consumer Price Index (CPI) for urban consumers, published by the Bureau of Labor Statistics. Increases are rounded down to the nearest multiple of $5.
- Application to Group Health Plans: The same caps extend to employer-sponsored group health plans and health insurance offered in connection with them. This is achieved through amendments to:
- The Public Health Service Act (overseen by the Department of Health and Human Services).
- The Employee Retirement Income Security Act (ERISA, overseen by the Department of Labor).
- The Internal Revenue Code (enforced by the IRS).
- Effective Date: Changes apply to plan years beginning on or after January 1, 2026.
Significant Changes to Existing Law
- Amends Section 1302(c) of the ACA to add a specific cap on prescription drug cost-sharing, separate from the general out-of-pocket maximum (currently $9,450 for individuals and $18,900 for families in 2025, subject to annual adjustments).
- Introduces new sections in the Public Health Service Act (Section 2799A-6), ERISA (Section 721), and Internal Revenue Code (Section 9821) to enforce the caps uniformly across group health plans, ensuring consistency between marketplace and employer plans.
- These changes build on but do not replace existing protections, focusing solely on prescription drugs rather than all medical services.
Potential Impacts
- On Citizens: Could make prescription drugs more affordable by limiting high out-of-pocket expenses, particularly for those with chronic conditions requiring ongoing medications. This may reduce financial stress and improve access to necessary treatments.
- On Government Agencies: The Department of Health and Human Services (HHS), Department of Labor (DOL), and Internal Revenue Service (IRS) will need to update regulations, guidance, and enforcement mechanisms to implement and monitor compliance, potentially increasing administrative workload.
- On Health Insurers and Employers: Insurers may need to redesign plans to meet the caps, which could lead to higher premiums to cover costs shifted from patients. Employers offering group plans must ensure compliance, affecting benefit offerings.
- No Apparent Impact on International Relations: The bill is domestic in scope, focusing on U.S. health insurance regulations.
Main Stakeholders Affected
- Patients and Enrollees: Primary beneficiaries, especially those with high prescription drug needs, as they face reduced costs.
- Health Insurers: Must adjust coverage to comply, potentially facing increased financial responsibility for drug costs above the cap.
- Employers: Sponsors of group health plans will need to verify and update benefits to avoid penalties under ERISA or tax rules.
- Pharmaceutical Companies: Indirectly affected, as lower patient costs might influence drug pricing negotiations or utilization patterns.
- Government Regulators: HHS, DOL, and IRS, responsible for oversight and enforcement.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens consumer protections under the ACA without altering its core structure, promoting uniformity across public and private insurance markets. Compliance failures could trigger enforcement actions, fines, or tax penalties under existing frameworks.
- Constitutional: Aligns with Congress's authority to regulate interstate commerce and health insurance under the Commerce Clause; no apparent challenges to federalism or individual rights.
- Political: As an expansion of ACA affordability measures, it could spark debates on healthcare costs and insurance mandates, but the bill itself is neutral in framing, emphasizing cost relief without mandating coverage expansions. Referred to multiple committees (Energy and Commerce, Education and Workforce, Ways and Means), indicating broad jurisdictional review.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Horsford, Steven [D-NV-4]
Cosponsors (9)
Rep. Figures, Shomari [D-AL-2], Rep. Stansbury, Melanie A. [D-NM-1], Rep. Johnson, Henry C. "Hank" [D-GA-4], Rep. Waters, Maxine [D-CA-43], Rep. Cherfilus-McCormick, Sheila [D-FL-20], Rep. Hayes, Jahana [D-CT-5], Rep. Thompson, Bennie G. [D-MS-2], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Vasquez, Gabe [D-NM-2]
Recent Actions
- 2025-04-01: 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.
- 2025-04-01: 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.
- 2025-04-01: 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.
- 2025-04-01: Introduced in House
- 2025-04-01: Introduced in House
Bill Versions
- Capping Prescription Costs Act of 2025 — issued 2025-04-01 — PDF (5 pages)