Rep. Auchincloss Proposes Cap on Prescription Drug Costs for ACA Marketplace Plans

Congressman Jake Auchincloss (D, MA-04) is proposing an amendment to the Patient Protection and Affordable Care Act that would place a limit on out-of-pocket spending for prescription drugs, announced the congressman's office on November 21st. 

The ACA Copay Cost and Affordability for Patients (CAP) Act, if passed by Congress, would place the following limits on prescription drug cost-sharing for ACA Marketplace enrollees, starting in 2027:

• $2,000 cap per year on prescription drugs with self-only ACA coverage; and
• $4,000 cap per year on prescription drugs with ACA family coverage.

In the proposed legislation, the congressman also proposes to increase the annual cap on prescription drug costs as premiums increase, beginning in 2028, based on the premium adjustment percentage set by the Secretary of Health and Human Services.

“Insurance doesn’t work if the co-pays and deductibles are unaffordable,” said Congressman Jake Auchincloss. “When people pay premiums to insurance companies, they should be able to trust that the insurer will cover them when a doctor prescribes a drug they need. My bill is a step towards repairing that trust.”

Pharmacy copay costs have increased for the average insured consumer by 36% from 2021 to 2023, said Peter Rubin, Executive Director of No Patient Left Behind.

“This bill will provide life-saving financial relief to millions of families. As prescription drug prices in the United States continue to spiral out of control, forcing families to choose between the medication they need and putting food on the table, Big Insurance’s pharmacy benefit manager subsidiaries are profiting handsomely,” said Wendell Potter, President of the Center for Health and Democracy and Founder of the Lower Out-of-Pockets NOW Coalition. “Over the past decade, the seven largest publicly traded health insurers have reported more than $500 billion in profits, including $146 billion spent on stock buybacks—profits extracted in part from unaffordable cost-sharing requirements that patients face at the pharmacy counter. Health care should be about patients, not profits. Which is why Congress should advance this vital legislation without delay.”

Thanks to the Office of Congressman Jake Auchincloss for sharing this news with Westwood Minute.

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