What does EXPANDING THE DRUG PRICE NEGOTIATION PROGRAM. of Lowering Drug Costs for American Families Act do?

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What does ESTABLISHING AN OUT-OF-POCKET LIMIT ON EXPENDITURES FOR of Lowering Drug Costs for American Families Act do?

This section amends Title XXVII of the Public Health Service Act and the Employee Retirement Income Security Act of 1974. It establishes limits on annual cost-sharing, including out-of-pocket expenses for prescription drugs, under group health plans and health insurance coverage. For plan years beginning in 2027, the prescription drug out-of-pocket cost-sharing limit is $2,000 for self-only coverage, doubling for other coverage. These limits are adjusted annually based on a 'premium adjustment percentage' calculated by the Secretary. The provisions are subject to a sunset clause, ceasing to apply for plan years beginning on or after January 1, 2027. Health insurance issuers must also offer coverage in levels specified under section 1302(d) of the Patient Protection and Affordable Care Act as plans with only enrollees under age 21. The section does not apply to dental-only plans.

What does REQUIREMENTS WITH RESPECT TO COST-SHARING FOR INSULIN of Lowering Drug Costs for American Families Act do?

This section amends both the Public Health Service Act (PHSA) and the Employee Retirement Income Security Act of 1974 (ERISA) to establish requirements regarding cost-sharing for certain insulin products. For plan years beginning on or after January 1, 2027, group health plans and health insurance issuers must provide coverage for 'selected insulin products'. Plans are prohibited from applying any deductible or imposing cost-sharing exceeding $35 per 30-day supply, or 25% of the negotiated price, whichever is lower. ‘Selected insulin products’ include at least one of each dosage form and type of insulin available. The legislation clarifies that plans are not required to cover insulin from out-of-network providers and may impose higher cost-sharing in such cases. Cost-sharing payments for insulin are to be counted towards any applicable deductible or out-of-pocket maximum.