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Congress·In Committee·H.R. 6166

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

Lowering Drug Costs for American Families Act

4 months ago·View on Congress.gov
⏸

Stalled

No legislative action in over 90 days.

Legislative Progress

House
Senate
President
Law

Key Points

  • Congress would expand Medicare drug price negotiations by increasing the number of drugs negotiated each year from 20 to 50.

    From policy text

    “Section 1192(a)(4) of the Social Security Act (42 U.S.C. 1320f-1(a)(4)) is amended by striking ``20'' each place it appears and inserting ``50'' in each such place.”
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  • 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.

    From policy text

    “The Secretary shall not be treated as having in effect an agreement under the program under this part with a group health plan or health insurance issuer offering group or individual health insurance coverage with respect to a price applicability period and a selected drug with respect to such period if such a plan or issuer affirmatively elects, through a process specified by the Secretary, not to participate under the program with respect to such period and drug.”
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  • 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.

    From policy text

    “to apply prescription drug inflation rebates under the Medicare program to drugs furnished in the commercial market”
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  • 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.

    From policy text

    “For plan years beginning on or after January 1, 2027, a group health plan or health insurance issuer offering group or individual health insurance coverage shall provide coverage of selected insulin products, and with respect to such products, shall not-- ``(1) apply any deductible; or ``(2) impose any cost-sharing in excess of the lesser of, per 30-day supply-- ``(A) $35;”
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Prescription DrugsHealthcareMedicare MedicaidConsumer Protection

Impact Analysis

Personal Impact

How this policy affects specific groups of people

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

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.

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. Always verify with official sources.