Caps what people pay out of pocket for prescription drugs in private health coverage. Starting in 2026, costs for covered prescription drugs can’t exceed $2,000 per person or $4,000 per family each plan year. After you hit the cap, the plan must cover additional covered drug costs for the rest of that year.

The caps apply to marketplace qualified health plans and employer group health plans (including self‑insured plans). The limits rise each year with medical inflation and are rounded down to the nearest $5. The rule takes effect for plan years beginning on or after January 1, 2026.