119-s529

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 529 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 529

 To limit cost-sharing for prescription drugs, and for other purposes.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 February 11, 2025

Mr. Warnock (for himself, Ms. Baldwin, Mr. Booker, Mr. Blumenthal, Mr. 
Fetterman, Mrs. Gillibrand, Mr. Heinrich, Mr. Kim, Ms. Klobuchar, Mrs. 
 Murray, and Mr. Welch) introduced the following bill; which was read 
 twice and referred to the Committee on Health, Education, Labor, and 
 Pensions

_______________________________________________________________________

 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 (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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