“To amend the Patient Protection and Affordable Care Act to establish an out-of-pocket limit on spending for prescription drugs.”
No CRS summary available for this bill.
This section establishes an annual limitation on cost-sharing for prescription drugs under essential health benefits packages of $2,000 for self-only coverage (twice that amount for other coverage) for plan years beginning on or after January 1, 2027, with subsequent annual increases by the premium adjustment percentage (rounded to the next lowest multiple of $50). (Thus, after an enrollee reaches this limit, the health plan may impose no further cost-sharing for prescription drugs that plan year, regardless of the general cost-sharing limit under subsection (c)(1).) It also makes conforming amendments to (1) apply the premium adjustment percentage to this new limit; (2) permit waiver of cost-sharing limits under PPACA §1302(e) for prescription drugs after this limit is reached; and (3) conform the parallel limit under PHSA §2707(b).