Congress caps what insurers can charge for prescription drugs at pharmacy.

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.
• Pharmacy benefit managers are explicitly required to comply, but enforcement mechanism and penalties for non-compliance are not specified in the bill text.
• The bill does not address whether plans can offset capped cost-sharing by raising premiums, deductibles on other services, or reducing drug formularies.
• Individual market insurers are covered, but the impact on premium pricing and plan availability in states with thin individual markets is unclear.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Patients gain direct protection against excessive cost-sharing on prescription drugs; out-of-pocket costs are capped at the nationwide average price, reducing financial barriers to medication access. Insurers and PBMs lose pricing discretion but the constraint is tied to actual market prices, not an arbitrary floor.

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)

Named in the bill

Health insurance issuers, Group health plans, Pharmacy benefit managers (PBMs), In-network pharmacies, Centers for Medicare & Medicaid Services (CMS), Public Health Service Act, Employee Retirement Income Security Act (ERISA), Internal Revenue Code

Where it stands

• Aug 20, 2026 — Introduced · Congress.gov: “Introduced in House”
• Aug 20, 2026 — Referred to House Committee on Education and Workforce and House Committee on Ways and Means · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.