ACA Copay CAP Act of 2025

119 HR 6171 IH: ACA Copay Cost and Affordability for Patients Act of 2025 U.S. House of Representatives 2025-11-20 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. I 119th CONGRESS 1st Session H. R. 6171 IN THE HOUSE OF REPRESENTATIVES November 20, 2025 Mr. Auchincloss introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Patient Protection and Affordable Care Act to establish an out-of-pocket limit on spending for prescription drugs. 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 . 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) .