ACA Copay CAP Act of 2025

[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.


_______________________________________________________________________


                    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.

    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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