H.R. 10133, Consumer Drug Cost Protection. Quorum's AI analysis reads it as a net benefit — and names who gains.

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.

The analysis names patients and consumers (reduced out-of-pocket drug costs) — and 1 more group — among the beneficiaries.

The trade-off

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.

Transparency scores 85%, with a medium warning level and no provisions unrelated to the bill's subject.

Who is behind it

Filed by Hillary Scholten.