H.R. 10133: Fair Prescription Pricing Act of 2026

This bill would limit how much people in certain health plans can be charged out of pocket for covered prescription drugs bought at an in-network pharmacy.

What the bill would do

For health plans starting on or after the date the bill becomes law, group health plans and health insurers could not require a patient to pay more than the nationwide average consumer purchase price for a covered outpatient drug over the prior 12 months.

This cap would apply to common forms of prescription cost sharing, including:

• Deductibles
• Copayments
• Coinsurance

The price limit would be based on federal survey data used for Medicaid drug pricing calculations.

Which plans are covered

• Group health plans
• Group health insurance coverage
• Individual health insurance coverage

The bill amends three laws so the same rule applies in different settings:

• The Public Health Service Act
• ERISA, which covers many employer-sponsored health plans
• The Internal Revenue Code, which covers tax-related rules for health plans

How it would work in practice

If a covered drug is dispensed by an in-network pharmacy, the patient’s share of the cost could not be higher than the drug’s nationwide average consumer purchase price for the previous year. Plans would be required to make sure any pharmacy benefit manager they use follows this rule as well.

What the bill does not say

• It does not set the full price of drugs.
• It does not apply to all pharmacies, only in-network pharmacies.
• It does not appear to change whether a drug is covered, only the patient’s out-of-pocket amount for covered drugs.

Relevant Companies

• CVS — CVS Health operates a large pharmacy benefit manager and retail pharmacy network, so the bill could affect how it administers drug cost sharing for health plans.
• CI — Cigna, through its health services businesses, provides pharmacy benefit management services that could be affected by new limits on drug cost sharing.
• UNH — UnitedHealth, through Optum and its insurance operations, could be affected in administering plan drug cost-sharing rules.
• ELV — Elevance Health offers health insurance plans and pharmacy-related services that may need to comply with the new cost-sharing cap.
• HUM — Humana sponsors and administers health plans, including Medicare-related products, which could be affected if similar pharmacy benefit structures are used.
• MCK — McKesson is a large drug distributor and pharmacy-services company that could be indirectly affected by changes in plan reimbursement and pharmacy pricing practices.
• CI — Express Scripts is part of Cigna, and its PBM operations could be directly affected by the bill’s requirement that PBMs follow the cost-sharing cap.