Capping Prescription Costs Act of 2025

Bill Summary: Capping Prescription Costs Act of 2025 (H.R. 2553)

Overview

The Capping Prescription Costs Act of 2025 is a legislative proposal designed to limit the amount of money individuals and families must pay out-of-pocket for prescription drugs covered by their health insurance plans. The bill aims to reduce the financial burden of medication by establishing a nationwide annual ceiling on prescription drug cost-sharing.

Key Provisions

1. Annual Cost-Sharing Limits

The bill establishes a strict limit on the amount a patient must pay for prescription drugs per plan year.
* Initial Caps (2026): For plan years beginning in 2026, the maximum out-of-pocket cost for prescription drugs is set at:
* $2,000 per individual.
* $4,000 per family.
* Future Adjustments (2027 and later): To account for inflation, the caps will be adjusted annually based on the medical care component of the Consumer Price Index (CPI) for all urban consumers.
* Rounding: Any annual increase resulting from the CPI adjustment will be rounded down to the nearest $5 increment.

2. Scope of Application

The bill ensures that these caps apply across nearly all types of health insurance coverage by amending several key federal laws:
* Qualified Health Plans: Amends the Patient Protection and Affordable Care Act (ACA) to include these caps on individual marketplace plans.
* Group Health Plans: Amends the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code to ensure that employer-sponsored group plans and their insurers also adhere to these limits.

Who is Affected?

• Patients: Individuals and families with health insurance who pay co-pays, coinsurance, or deductibles for prescription medications will have a guaranteed upper limit on their annual spending.
• Insurance Issuers: Health insurance companies will be required to redesign their plan structures to ensure cost-sharing does not exceed the legal limits.
• Employers: Companies providing group health insurance must ensure their plans comply with the new caps.

Timeline and Procedural Status

• Effective Date: The bill stipulates that these changes will take effect for plan years beginning on or after January 1, 2026.
• Current Status: The bill was introduced in the House on April 1, 2025. It has been referred to three committees for review:
  1. Committee on Energy and Commerce
  2. Committee on Education and Workforce
  3. Committee on Ways and Means