Lowering Drug Costs for American Families Act

Increased Negotiation Power: The bill increases the number of drugs subject to the negotiation program from 20 to 50 (Section 101(a)). This could provide more opportunities for negotiated prices on a wider variety of drugs.

Expanded Drug Price Negotiations to Commercial Market: The program would apply to participants, beneficiaries, or enrollees under group health plans or individual health insurance coverage (Section 101(b)). This expands the reach of price negotiations beyond just Medicare.

Lower Out-of-Pocket Costs for Insurance Holders: The bill establishes annual out-of-pocket limits for prescription drugs under group health plans and individual coverage (Section 301(b)(1)). For self-only coverage, the limit on prescription drug out-of-pocket cost-sharing would be $2,000 for plan years beginning in 2027 (Section 301(b)(2)(A)(i)).

Affordable Insulin Access: For plan years beginning on or after January 1, 2027, health plans must provide coverage for selected insulin products without applying a deductible (Section 302(a)(1)). Furthermore, cost-sharing for these insulin products is capped at the lesser of $35 per 30-day supply or 25 percent of the negotiated price (Section 302(a)(2)).

Insurance Opt-Outs: Health insurance issuers or group health plans can affirmatively elect not to participate in the drug price negotiation program for specific drugs or periods (Section 101(d)(1)(2)).

Public Disclosure of Nonparticipation: Any insurance issuer or plan that chooses not to participate in the drug price negotiation program must publicly disclose that election (Section 101(d)(1)(2) and Section 101(e)(2)).