I 
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 pre-
scription drugs. 
Be it enacted by the Senate and House of Representa-
tives 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’’. 
VerDate Sep 11 2014 
01:35 Dec 04, 2025
Jkt 069200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H6171.IH
H6171
kjohnson on DSK7ZCZBW3PROD with $$_JOB
SEC. 2. ESTABLISHING AN OUT-OF-POCKET LIMIT ON 
SPENDING FOR PRESCRIPTION DRUGS. 
(a) IN GENERAL.—Section 1302(c) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18022(c)) 
is amended— 
(1) by inserting after paragraph (1) the fol-
lowing new paragraph: 
‘‘(2) ANNUAL
LIMITATION
ON
COST-SHARING 
FOR DRUGS.— 
‘‘(A) IN GENERAL.—The annual cost-shar-
ing incurred under a health plan with respect to 
prescription drugs dispensed during a plan year 
beginning on or after January 1, 2027, shall 
not exceed the dollar amount specified in sub-
paragraph (B) with respect to such plan year. 
‘‘(B) AMOUNT SPECIFIED.—For purposes 
of subparagraph (B), the dollar amount speci-
fied in this subparagraph with respect to a plan 
year is the following: 
‘‘(i) With respect to self-only cov-
erage— 
‘‘(I) for plan years beginning in 
2027, $2,000; and 
‘‘(II) for plan years beginning in 
2028 or a subsequent year, the dollar 
amount in effect under this subpara-
VerDate Sep 11 2014 
01:35 Dec 04, 2025
Jkt 069200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6171.IH
H6171
kjohnson on DSK7ZCZBW3PROD with $$_JOB
graph 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 be-
ginning 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 
VerDate Sep 11 2014 
01:35 Dec 04, 2025
Jkt 069200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6171.IH
H6171
kjohnson on DSK7ZCZBW3PROD with $$_JOB
U.S.C. 18022(e)(1)(B)(i)) is amended by inserting 
‘‘and except, with respect to plan years beginning on 
or after January 1, 2027, in the case of an indi-
vidual who has incurred cost-sharing expenses with 
respect to prescription drugs in an amount equal to 
the limitation in effect under subsection (c)(2) for 
such plan year, for benefits consisting of prescrip-
tion drugs’’ after ‘‘section 2713’’. 
(2) PHSA.—Section 2707(b) of the Public 
Health Service Act (42 U.S.C. 300gg–6(b)) is 
amended by inserting ‘‘or (2)’’ after ‘‘paragraph 
(1)’’. 
Æ 
VerDate Sep 11 2014 
01:35 Dec 04, 2025
Jkt 069200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H6171.IH
H6171
kjohnson on DSK7ZCZBW3PROD with $$_JOB