H.R. 6171

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6171 Introduced in House (IH)]

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119th CONGRESS
1st Session
H. R. 6171

To amend the Patient Protection and Affordable Care Act to establish an 
out-of-pocket limit on spending for prescription drugs.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

November 20, 2025

Mr. Auchincloss introduced the following bill; which was referred to 
the Committee on Energy and Commerce

_______________________________________________________________________

A BILL

To amend the Patient Protection and Affordable Care Act to establish an 
out-of-pocket limit on spending for prescription drugs.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``ACA Copay Cost and Affordability for 
Patients Act of 2025'' or the ``ACA Copay CAP Act of 2025''.

SEC. 2. ESTABLISHING AN OUT-OF-POCKET LIMIT ON SPENDING FOR 
PRESCRIPTION DRUGS.

(a) In General.--Section 1302(c) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022(c)) is amended--
(1) by inserting after paragraph (1) the following new 
paragraph:
``(2) Annual limitation on cost-sharing for drugs.--
``(A) In general.--The annual cost-sharing incurred 
under a health plan with respect to prescription drugs 
dispensed during a plan year beginning on or after 
January 1, 2027, shall not exceed the dollar amount 
specified in subparagraph (B) with respect to such plan 
year.
``(B) Amount specified.--For purposes of 
subparagraph (B), the dollar amount specified in this 
subparagraph with respect to a plan year is the 
following:
``(i) With respect to self-only coverage--
``(I) for plan years beginning in 
2027, $2,000; and
``(II) for plan years beginning in 
2028 or a subsequent year, the dollar 
amount in effect under this 
subparagraph for plan years beginning 
in 2027, increased by an amount equal 
to the product of that amount and the 
premium adjustment percentage under 
paragraph (4) for the calendar year.
``(ii) With respect to coverage other than 
self-only coverage, for plan years beginning in 
2027 or a subsequent calendar year, twice the 
amount in effect under clause (i) for such plan 
year.
If the amount of any increase under clause (i) is not a 
multiple of $50, such increase shall be rounded to the 
next lowest multiple of $50.''; and
(2) in paragraph (4)--
(A) by striking ``paragraph (1)(B)(i)'' and 
inserting ``paragraphs (1) and (2)''; and
(B) by striking ``(as determined by the 
Secretary)'' and inserting ``(or, for purposes of 
paragraph (2), for 2027), as determined by the 
Secretary''.
(b) Conforming Amendments.--
(1) PPACA.--Section 1302(e)(1)(B)(i) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 
18022(e)(1)(B)(i)) is amended by inserting ``and except, with 
respect to plan years beginning on or after January 1, 2027, in 
the case of an individual who has incurred cost-sharing 
expenses with respect to prescription drugs in an amount equal 
to the limitation in effect under subsection (c)(2) for such 
plan year, for benefits consisting of prescription drugs'' 
after ``section 2713''.
(2) PHSA.--Section 2707(b) of the Public Health Service Act 
(42 U.S.C. 300gg-6(b)) is amended by inserting ``or (2)'' after 
``paragraph (1)''.
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