The Capping Prescription Costs Act would limit cost-sharing under marketplace health plans and group health plans by placing a cap on the cost of prescription drugs for individuals and families
The U.S. spends more than any other country on prescription drugs according to the GAO
According to data from NiceRX, Georgia has one of the highest average out-of-pocket costs for prescriptions drugs in the country while millions of Georgians have chronic conditions
Senator Reverend Warnock: “I’m proud to be leading the effort in the Senate to combat the rising out-of-pocket costs for prescriptions drugs that we are seeing all over the country, especially in Georgia, by capping what coverage plans can charge families and individuals”
ICYMI: The Staggering Cost of Prescription Drugs in Georgia—Read on State Affairs
New legislation is proudly supported by Community Catalyst, Public Citizen, Families USA, and Protect Our Care
Washington, D.C. – Today, U.S. Senator Reverend Raphael Warnock (D-GA) introduced new legislation to save families and individuals money on their medications and lower prescription drug costs. The Capping Prescription Costs Act will take proactive steps to protect Americans from rising prescription drug costs by limiting cost-sharing for prescriptions under marketplace health plans and group health plans to $250 per month for an individual and $500 per month for a family. One in four Americans taking a prescription drug has reported skipping doses or cutting pills in half due to costs.
“In a country as rich and remarkable as the United States, it is shameful that so many hardworking people have to ration their medicines, skip prescription refills, and make other tough tradeoffs about their care because they cannot afford the medication they need to stay healthy,” said Senator Reverend Warnock. “I’m proud to be leading the effort in the Senate to combat the rising out-of-pocket costs for prescriptions drugs that we are seeing all over the country, especially in Georgia, by capping what coverage plans can charge families and individuals.”
“I have firsthand experience with the exorbitant cost of prescription medication. When my daughter was diagnosed with a chronic illness, the medication her doctor prescribed cost $10,000 per month. My insurance company refused coverage, and I fought until they relented,” said Congresswoman Manning. “I came to Congress to help other families who struggle to pay for their medications. I am proud to introduce this bill to limit the amount families will have to pay for their medications and to help ensure that North Carolinians and people across the country will not have to go without medication they need to stay healthy.”
According to the Congressional Research Service, many private health insurance plans place an annual cap on enrollee out-of-pocket spending for covered health care services, after which the payer covers the cost. Currently, for 2021, the ACA caps out-of-pocket spending—for all health care expenses, including prescription drug costs—at $8,550 per year for self-only coverage and $17,100 per year for family coverage. Under the Capping Prescription Costs Act, individuals would not pay more than $3,000 and families no more than $6,000 per year for prescription drugs. Importantly, the legislation would not increase monthly premium plans.
Senator Warnock has been a champion in the Senate for strengthening health care access and lowering health care costs for Georgians. In Georgia, 32 percent of residents reported they stopped taking medication due to costs. The annual average cost of prescription drug treatment in Georgia rose nearly 58 percent between 2012 and 2017, adding as much as $1,000 to the cost of some brand-name medication. According to data from NiceRX, Georgia has one of the highest average out-of-pocket costs for prescriptions drugs in the country while millions of Georgians have chronic conditions like cancer, diabetes, and heart disease that require specialty drugs for treatment and management.
The Capping Prescription Costs Act is cosponsored by U.S. Senators Amy Klobuchar (D-MN), Tammy Baldwin (D-WI), Jack Reed (D-RI) , Patty Murray (D-WA) , Tina Smith (D-MN), Martin Heinrich (D-NM), Richard Blumenthal (D-CT) , Mazie Hirono (D-HI), and Chris Van Hollen (D-MD). Companion legislation is being led in the U.S. House by Representative Kathy Manning (NC-06).
Read the full bill text here.
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