Fair Prescription Pricing Act of 2026
- Sponsor
- Rep. Scholten, Hillary J. [D-MI-3]
- Committees
- Education and Workforce Committee (primary)
- Last action
- Aug 20, 2026
Bottom line
The bill aims to reduce out-of-pocket prescription drug costs for consumers by setting a ceiling on patient cost-sharing based on the nationwide average consumer purchase price.
What it actually does
This bill, the 'Fair Prescription Pricing Act of 2026,' amends the Public Health Service Act, ERISA, and the Internal Revenue Code to cap patient cost-sharing for covered outpatient prescription drugs. Specifically, it mandates that deductibles, coinsurance, and copayments for in-network pharmacy dispensed drugs cannot exceed the nationwide average of consumer purchase prices for that drug, as determined by a survey referenced in the Social Security Act. It also requires health plans and issuers to ensure their pharmacy benefit managers (PBMs) comply with this new cap.
Proponents argue
Proponents argue that this legislation will significantly reduce the financial burden on patients, making essential prescription medications more affordable and accessible. They contend that capping cost-sharing at average consumer prices will protect individuals from exorbitant out-of-pocket expenses, especially for high-cost drugs, and address perceived price gouging within the pharmaceutical supply chain. This measure is seen as a direct way to ensure that patients are not deterred from filling prescriptions due to cost.
Opponents contend
Opponents may argue that while the intent to lower patient costs is laudable, this bill could introduce significant market distortions. They might contend that health plans and insurers, faced with higher costs if patient cost-sharing is capped below their current reimbursement rates, may respond by increasing premiums for all beneficiaries, narrowing drug formularies, or shifting costs to other healthcare services. Concerns could also be raised about the administrative complexity and potential inaccuracies in determining a 'nationwide average of consumer purchase prices' using a survey originally designed for manufacturer prices.
The bill is concise, making it accessible for a quick read, but its implications require deeper consideration beyond the text itself.
Section 1
Short Title
This section establishes the official short title of the Act as the 'Fair Prescription Pricing Act of 2026'. This is the common name by which the bill would be known and referred to if enacted into law.
Supporters argue
Establishing a clear short title helps in easily identifying and discussing the legislation, making it more accessible to the public and policymakers.
Critics contend
No specific opposition is typically raised against the short title of a bill, as it is a procedural element.
Tradeoffs
None inherent in the short title itself.
Section 2(a), adding Section 2799A-12 to the Public Health Service Act
PHSA Amendment: Limitation on Cost Sharing for Drugs
This provision amends the Public Health Service Act to prohibit group health plans and health insurance issuers (both group and individual coverage) from imposing cost-sharing for covered outpatient drugs dispensed by in-network pharmacies that exceeds the nationwide average of consumer purchase prices for that drug. This cap applies for plan years beginning on or after the bill's enactment date, with the average price determined using a specific Social Security Act survey. It also explicitly requires plans and issuers to ensure their Pharmacy Benefit Managers (PBMs) comply with this new cost-sharing limit.
Section 2(b), adding Section 727 to ERISA
ERISA Amendment: Limitation on Cost Sharing for Drugs
This section mirrors the PHSA amendment by applying the same cost-sharing limitation to group health plans and health insurance issuers offering group coverage under the Employee Retirement Income Security Act of 1974 (ERISA). It prohibits cost-sharing for covered outpatient drugs from exceeding the nationwide average of consumer purchase prices and requires compliance from PBMs. This ensures that employer-sponsored health plans, which are largely governed by ERISA, are also subject to the new drug cost-sharing cap.
Section 2(c), adding Section 9827 to the Internal Revenue Code of 1986
IRC Amendment: Limitation on Cost Sharing for Drugs
This section amends the Internal Revenue Code of 1986 to apply the same cost-sharing limitation to group health plans. It stipulates that cost-sharing for covered outpatient drugs dispensed by an in-network pharmacy cannot exceed the nationwide average of consumer purchase prices. Like the other amendments, it requires group health plans to ensure their PBMs comply. This amendment reinforces the mandate through tax law, providing an additional layer of enforcement and applicability.
The bill mandates that the 'nationwide average of consumer purchase prices' for a drug will be determined using data from a survey specified in the Social Security Act, which is traditionally used for calculating average manufacturer prices (AMP) for Medicaid drug rebates.
Section 2(a), (b), and (c) of the bill, specifically the phrase "(as determined using information from the survey described in section 1927(f)(1)(A)(i) of the Social Security Act)"
Why it matters:This is likely standard legislative practice to leverage existing statutory definitions and data collection mechanisms rather than creating entirely new ones. However, applying a survey designed for manufacturer prices to 'consumer purchase prices' introduces a technical challenge that might be less obvious without deeper scrutiny.
Case for: Proponents would argue that leveraging an existing, established data collection mechanism provides a ready-made framework for determining drug prices, avoiding the need to create new, potentially costly and time-consuming bureaucratic processes. This approach aims for efficiency and consistency.
Case against: Critics might argue that a survey designed to capture manufacturer prices for Medicaid rebates may not accurately reflect the 'nationwide average of consumer purchase prices,' which can vary significantly due to insurance coverage, pharmacy markups, and patient assistance programs. This could lead to an inaccurate or inappropriate cap, potentially distorting the market or failing to achieve the intended consumer savings effectively.
Estimated impact: This technical detail has a high impact on the practical implementation and effectiveness of the bill's core cost-sharing limitation, as it dictates the very metric used to set the cap. Its accuracy and applicability are central to the bill's success.