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Congress·In Committee·3 months ago

House Bill Would Triple Medicare Drug Negotiations to 50 Drugs, Cap Out-of-Pocket Costs

Also known as: Lowering Drug Costs for American Families Act

Legislative Progress

✓ Filed
Review
House
Senate
President

Impacts

Positive Impacts(3)
Chronic Illness
Helps
Medicare
Helps
Retiree
Helps

Key Points

  • Congress would expand Medicare drug price negotiations by increasing the number of drugs negotiated each year from 20 to 50.
  • The bill would let private health plans (job-based and individual plans) choose to use Medicare’s negotiated drug prices; plans can opt out, and opt-outs would be made public.
  • For Medicare drug negotiations starting in 2028, negotiators would have to consider average drug prices in Australia, Canada, France, Germany, Japan, and the United Kingdom.
  • It would extend Medicare-style inflation rebates to drugs sold in the commercial market, aiming to discourage big price hikes outside Medicare too.
  • Starting in 2027, private insurance plans would face a $2,000 yearly cap on what people pay out of pocket for prescription drugs, and selected insulin would be capped at $35 per 30-day supply with no deductible.
Prescription DrugsHealthcareMedicare MedicaidConsumer Protection

Milestones

2 milestones2 actions
Nov 20, 2025House

Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Nov 20, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

2027-01-01

Private-plan prescription drug out-of-pocket cap begins ($2,000 self-only; about $4,000 family)

If you have very high prescription costs on an employer plan or marketplace plan, your pharmacy spending should stop climbing after you hit the annual cap in a plan year.

2027-01-01

Private-plan insulin cost rules start (no deductible; $35 per 30-day supply cap for selected insulin)

People who use insulin should see lower, more predictable costs at the pharmacy for at least one insulin in each main type and form that the plan selects.

Before the start of the plan year for which the opt-out applies

Plans and insurers must make public if they opt out of negotiated pricing for a selected drug

At open enrollment, you may be able to compare plans based on whether they chose not to use the negotiated price for certain drugs you need.

Calendar quarters beginning after enactment

Medicare inflation-rebate changes apply to quarters after the law is enacted

Drug makers could owe larger rebate payments when prices rise quickly, which can reduce pressure for price increases and may lower Medicare costs over time.

2028-01-01

Medicare negotiations must consider average international prices for new negotiation years

For drugs selected for negotiation for 2028 and later, the government would use prices in countries like Canada, France, Germany, Japan, and the United Kingdom as a reference point, which can push negotiated prices lower.

Related News

3 articles
Fierce Healthcare·3 months ago

House Democrats introduce bill to expand drug price negotiation to commercial market

House Democrats introduced the Lowering Drug Costs for American Families Act to expand Medicare's negotiation power from 20 to 50 drugs annually and extend those prices to the commercial market, potentially reaching 164 million workers who receive coverage through employers.

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BioSpace·over 2 years ago

How Drug Prices Differ in the U.S. Versus Other Countries

The bill would increase the number of drugs Medicare negotiates and require the HHS Secretary to consider international prices from countries like Australia and the UK, addressing the fact that Americans pay significantly more for brand-name drugs than international counterparts.

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Health Care News·over 2 years ago

U.S. Lawmakers Introduce Lowering Drug Costs for American Families Act

Democratic leaders introduced legislation to build on the Inflation Reduction Act by allowing private health plans to access Medicare-negotiated prices and capping out-of-pocket costs for insulin at $35 per month for those with commercial insurance.

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Source Information

Document Type

Congressional Bill

Official Title

Lowering Drug Costs for American Families Act

Bill NumberHR 6166
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sponsor

Cosponsors

(45)
D: 45

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.