S.529 - Capping Prescription Costs Act of 2025 (119th Congress)
Summary
The "Capping Prescription Costs Act of 2025" aims to limit cost-sharing for prescription drugs under qualified health plans and group health plans. It amends the Patient Protection and Affordable Care Act, the Public Health Service Act, the Employee Retirement Income Security Act, and the Internal Revenue Code of 1986. The bill sets a cost-sharing limit of $2,000 per individual and $4,000 per family for plan years beginning in 2026, with adjustments for inflation in subsequent years.
Expected Effects
If enacted, this bill would reduce out-of-pocket expenses for prescription drugs for many Americans. It would impact health insurance issuers and group health plans, requiring them to comply with the cost-sharing limits. The changes would take effect for plan years beginning on or after January 1, 2026.
Potential Benefits
- Reduced Out-of-Pocket Costs: Individuals and families could see significant savings on prescription drug costs.
- Improved Healthcare Access: Lower costs may improve access to necessary medications, leading to better health outcomes.
- Financial Security: Capping costs can protect individuals and families from unexpected and burdensome medical expenses.
- Predictable Healthcare Spending: The cost-sharing limits provide more predictability in healthcare budgeting.
- Potential for Better Health Outcomes: Increased access to medications can improve overall health and reduce the severity of illnesses.
Potential Disadvantages
- Increased Premiums: Health insurance companies may raise premiums to offset the cost of capping prescription drug cost-sharing.
- Reduced Benefits: Insurers might reduce other benefits or services to compensate for the capped prescription costs.
- Administrative Costs: Implementing and managing the cost-sharing limits could increase administrative costs for insurers and employers.
- Potential for Gaming the System: Insurers might try to shift costs in other ways, such as increasing deductibles or co-pays for other services.
- Impact on Innovation: Reduced profitability for pharmaceutical companies could potentially slow down research and development of new drugs.
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution, as it aims to improve access to healthcare and reduce financial burdens related to prescription drugs. Specifically, the preamble of the Constitution states the goal to "promote the general Welfare". The bill's provisions relating to health plans fall under the power of Congress to regulate interstate commerce, as health insurance companies operate across state lines. The bill does not appear to infringe upon any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).