Before 2028 the caps are one dollar and three dollars
Making further consolidated appropriations for the fiscal year ending September 30, 2026, and for other purposes, section 6219, Sec. 6219.
Written by .
Before 2028 the caps are one dollar and three dollars
The document says “is amended”Who acts: CongressHow: statuteSec. 6219 in the PDF
What the document says
“for a generic drug or a preferred drug that is a multiple source drug (as defined in section 1927(k)(7)(A)(i)), $1 or, if less, the copayment amount applicable to an individual under clause (iii); and”
Section 6219 rewrites section 1860D-14(a)(1)(D)(ii) of the Social Security Act. For a plan year before 2028, the copayment may not exceed $1 for a generic drug or a preferred multiple source drug, or the individual's applicable copayment if that is less, and may not exceed $3 for any other drug, or the individual's applicable copayment if that is less.
What the document actually says
“for a generic drug or a preferred drug that is a multiple source drug (as defined in section 1927(k)(7)(A)(i)), $1 or, if less, the copayment amount applicable to an individual under clause (iii); and”
That sentence, in plain words
For a generic drug or a preferred drug with more than one maker, the copay is one dollar. If the person's own copay is less, that lower one applies.
What this is about
A copay is what a person pays at the counter. A generic is a drug that copies a brand name one. The cap for other drugs is three dollars.
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Consolidated Appropriations Act, 2026, Public Law 119-75, sec. 6219, 140 Stat. 655 (2026). https://www.govinfo.gov/content/pkg/PLAW-119publ75/html/PLAW-119publ75.htm
This page
“Before 2028 the caps are one dollar and three dollars,” Consolidated Appropriations Act, 2026, section 6219, Sec. 6219. Read the Mandate, https://readthemandate.org/consolidated-appropriations-act-2026/proposal/sec6219-caps-before-2028/ (retrieved August 26, 2026).
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