Congress caps what insurers can charge for prescription drugs at pharmacy.
H.R. 10133 — Fair Prescription Pricing Act of 2026 · Filed by Hillary Scholten (D-MI) · Introduced Aug 20, 2026 · Referred to committee
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What it does
This bill caps what health insurance plans and insurers can charge patients as out-of-pocket costs (copays, coinsurance, deductibles) for prescription drugs at in-network pharmacies. The cap is set at the nationwide average price consumers actually pay for each drug, measured annually. The bill applies to group health plans, individual insurance, and requires pharmacy benefit managers to comply with the same limit.
Why we flagged it
The bill's core mechanism is a direct consumer protection: capping patient out-of-pocket drug costs at a market-based benchmark. It is not a subsidy, tax change, or deregulation—it is a cost-sharing restraint on insurers and PBMs.
What the text implies
- The cap applies only to in-network pharmacies; out-of-network costs are not addressed, potentially incentivizing plans to narrow networks or shift patients to preferred pharmacies.
- The nationwide average price benchmark may lag actual market prices by up to one year, creating a moving target that could be gamed through timing of price changes.
The full analysis lists 5 implications of this text.
Who stands to gain
patients and consumers (reduced out-of-pocket drug costs); low-income and chronically ill populations (disproportionate benefit from cost-sharing caps)