Sponsors (55)
Introduced November 20, 2025 by Frank Pallone · Last progress November 20, 2025
The bill substantially reduces out-of-pocket prescription costs and expands negotiation and benefit protections for many Americans—especially for insulin and individual/small-group enrollees—but shifts costs, administrative burdens, and regulatory risk onto insurers, providers, and manufacturers, which could lead to higher premiums, narrower networks, market disruption, or altered manufacturer behavior.
People in individual, small-group, and many commercial plans will face substantially lower out-of-pocket prescription drug costs because plans must cap patient cost-sharing at negotiated maximum fair prices and the bill creates an annual OOP drug cap (starting $2,000 in 2027, indexed thereafter).
People with diabetes will pay much less for selected insulin products due to low/no deductible rules and per‑month/per‑fill caps (≤ $35/30‑day or 25% of negotiated price), improving access and adherence.
More commercial payers being included by default and use of average international prices as benchmarks expands covered lives subject to negotiation and strengthens bargaining leverage to lower drug prices nationally.
Insurers, employers, pharmacies, and providers will face substantial new administrative and compliance burdens (applying caps, reporting, converting units, and disclosure), which can raise administrative costs and contribute to higher premiums or reduced plan offerings.
Pharmaceutical manufacturers may respond to higher rebate obligations and international benchmarking by raising list prices for non‑negotiated drugs, delaying or limiting U.S. launches, or reducing R&D investment, which could keep some prices high and harm access to new therapies.
If insurers or issuers opt out of applying negotiated prices, many enrollees will receive uneven benefits across plans and may lose access to lower negotiated price protections.
Based on analysis of 4 sections of legislative text.
Expands drug-price negotiation and rebate rules into the commercial market, defaults many private plans into negotiated pricing with opt-out, and caps OOP costs for individual/small-group plans beginning 2027 (including a $2,000 drug cap in 2027).
Expands and deepens federal drug-price rules to lower out-of-pocket costs and extend negotiated or inflation-adjusted pricing into more of the commercial market. It broadens the federal drug price negotiation program, requires commercial plans to default into the negotiated pricing (with an opt-out), extends prescription-drug inflation rebate calculations to drugs dispensed in the commercial market for Medicare Part B and Part D, and imposes new insurance market rules that require essential health benefits and cap annual out-of-pocket costs (including a $2,000 drug cap for 2027) for individual and small-group plans starting with 2027 plan years. The bill changes how drug units and billing are counted for rebate calculations, directs the Secretary to implement processes for plan participation and exclusions, and creates new ERISA-related requirements so small-group and individual market plans must meet the new benefit and cost-sharing rules. Some detailed amendment text is not provided in the summary, so certain formula details are unspecified here.