Sponsors (56)
Official title: To expand the drug price negotiation program under title XI of the Social Security Act and repeal certain changes to the program made by Public Law 119-21, to apply prescription drug inflation rebates under the Medicare program to drugs furnished in the commercial market, and to establish out-of-pocket limits on expenditures for prescription drugs under private health insurance.
Introduced November 20, 2025 by Frank Pallone · Last progress November 20, 2025
The bill meaningfully lowers and caps out‑of‑pocket prescription costs for many patients and expands federal price negotiation and transparency, but it also shifts costs, regulatory burdens, and some legal protections onto employers, plans, and states and risks reduced drug availability or benefit coverage for certain populations.
People with diabetes (and other insulin users) will pay much less at the pharmacy because insulin cost-sharing is capped at $35 per 30‑day supply or 25% of the negotiated price starting in 2027.
Medicare beneficiaries and other enrollees will face a hard annual out‑of‑pocket prescription drug limit (a $2,000 self‑only cap in 2027, indexed thereafter), sharply reducing the risk of catastrophic drug spending.
More high‑cost medicines will be subject to federal negotiation and plans must limit cost-sharing for negotiated drugs to the negotiated maximum fair price, likely lowering prices and out‑of‑pocket costs for many patients, including Medicare beneficiaries.
Drug manufacturers may respond to expanded negotiation and price constraints by reducing U.S. product availability or delaying new launches, which could limit treatment options for patients.
After 2026, narrowing federal EHB obligations for group plans could remove federally enforceable benefit standards for many employer plans, reducing guaranteed coverage protections for employees and dependents.
Indexing out‑of‑pocket limits to premium growth could allow caps to rise substantially if premiums increase rapidly, exposing consumers to larger future drug costs despite nominal caps.
Based on analysis of 4 sections of legislative text.
Expands federal drug price negotiations, applies negotiated maximum fair prices by default to commercial plans (opt‑out), revises rebate unit counts, and sets new 2027 insurance cost‑sharing limits including a $2,000 drug cap for individuals.
Expands the federal Drug Price Negotiation Program to cover more drugs and to apply negotiated maximum fair prices beyond Medicare to commercial group and individual health plans, with a default participation (opt‑out) rule for plans. It also changes how drug unit counts are calculated for inflation rebates, requires plans to cap cost‑sharing at negotiated prices, sets new out‑of‑pocket and benefit requirements for individual and small‑group markets starting in 2027, and adds an international price benchmark to negotiations beginning in 2028.