The ACA Copay CAP Act of 2025 would add a new cap on how much patients have to pay out-of-pocket for prescription drugs under health insurance plans. Beginning in 2027, individuals with self-only coverage would face an annual limit of $2,000 in drug copays and cost-sharing, while families with other coverage types would have a $4,000 annual cap. These dollar limits would increase each year based on premium adjustment percentages, rounded down to the nearest $50. Once a patient reaches their annual cap, their health plan would cover the full cost of prescription drugs for the rest of that year. The bill applies to all health plans regulated under the Affordable Care Act and takes effect for plan years beginning January 1, 2027.
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