Sponsors (55)
Introduced November 20, 2025 by Frank Pallone · Last progress November 20, 2025
The bill lowers drug costs for many Americans through expanded negotiation, insulin and annual out-of-pocket caps, and rebate adjustments while imposing new administrative burdens and creating risks of reduced drug availability, cost-shifting, and narrower enforceable benefits for some workers and enrollees.
Medicare beneficiaries and people with chronic conditions would face lower out-of-pocket drug costs because the bill expands federal negotiation of drug prices and requires plans to limit cost-sharing to negotiated maximums.
People with diabetes would pay much less for insulin because cost-sharing is capped at $35 per 30-day supply (or 25% of the negotiated price) starting in 2027.
Enrollees would face a hard annual prescription out-of-pocket cap (a $2,000 self-only limit in 2027, indexed thereafter), protecting many consumers from catastrophic drug spending.
Some group health plans and issuers may opt out of the cost-sharing substitution, leaving their enrollees with higher drug cost-sharing and creating uneven protection across people with employer coverage.
Drug manufacturers could respond to lower negotiated U.S. prices by limiting product availability or delaying launches in the U.S., which would reduce treatment options for patients.
Removing federal EHB obligations for group plans after 2026 and narrowing ERISA incorporation could reduce enforceable benefit protections, leaving some workers with narrower coverage and weaker legal recourse.
Based on analysis of 4 sections of legislative text.
Applies negotiated federal drug prices to many private plans, changes rebate unit counting, and imposes essential‑benefit and cost‑sharing limits for individual/small‑group plans beginning 2027.
Expands the existing federal drug price negotiation program so negotiated maximum fair prices can apply not just to Medicare drug plans but also to many employer-sponsored group plans, individual and small-group market plans, and issuers unless they opt out. Requires plans to limit enrollee cost‑sharing to amounts no greater than the negotiated price, directs the Secretary to use an average international market price in negotiations beginning in 2028, and creates public reporting of plans that decline to participate. The bill also changes how drug units are counted for inflation rebate calculations (including commercial market units and excluding certain 340B units beginning in 2026) and adds new statutory requirements that individual and small‑group plans cover essential health benefits and meet new annual and drug‑specific out‑of‑pocket caps for plan years starting in 2027.