This bill, titled the Fair Prescription Pricing Act of 2026, would add new limits to health coverage rules. For plan years starting on or after the law is enacted, group health plans and health insurance issuers offering group or individual coverage could not charge a patient more in cost sharing (deductibles, coinsurance, copayments) for a covered outpatient drug dispensed at an in-network pharmacy than the nationwide average consumer purchase price for that drug. The nationwide average would be the 1-year average ending on the first day of the plan year, using data from the survey referenced in section 1927(f)(1)(A)(i) of the Social Security Act. The bill adds matching requirements for plans governed by the Public Health Service Act, the Employee Retirement Income Security Act (ERISA), and the Internal Revenue Code. Plans must also require any pharmacy benefit manager (PBM) they use to follow the same limit. The bill defines covered outpatient drug by reference to section 1927(k) and defines in-network pharmacy as a pharmacy with a contract to dispense the drug under the plan or coverage.
If you get health coverage through a group plan or buy individual coverage, this bill would limit how much you can be required to pay out of pocket for covered outpatient drugs obtained at in-network pharmacies. Cost-sharing limits would be based on the nationwide average consumer purchase price for each drug for the prior 1-year period, as determined by the specified survey. Employers, issuers, and their PBMs would need to follow these limits for plan years that begin after the law takes effect.
No publicly available information.
The bill's text states its purpose: to ensure that cost sharing for a drug does not exceed the nationwide average of consumer purchase prices for that drug. It applies that limit across group and individual coverage and requires PBMs to comply. The bill would take effect for plan years beginning on or after the date of enactment.
No publicly available information.