S. 475 – RxCAP Act of 2019

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Updated April 14, 2026 at 1:45 AM UTC

The RxCAP Act of 2019 would change Medicare Part D rules so that seniors and people with disabilities no longer have to pay any cost‑sharing once they reach the annual out‑of‑pocket threshold. Starting in the 2020 plan year, the bill removes all additional charges above that limit, aiming to protect beneficiaries from catastrophic prescription‑drug costs. The change applies to all Medicare Part D enrollees, while keeping the existing cost‑sharing rules in place for plan years 2006‑2019.

Key Provisions

Eliminates all cost‑sharing for prescription drugs above the Medicare Part D annual out‑of‑pocket threshold for plan year 2020 and later.
Keeps the current cost‑sharing structure for plan years 2006‑2019.
Updates related sections of the Social Security Act and the low‑income subsidy rules to reflect the new cost‑sharing elimination.

Legislative Activity

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1 earlier action

SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance.

Finance Committee

February 13, 2019

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SenateIntro Referral

Introduced in Senate

February 13, 2019

SenateIntro Referral

Read twice and referred to the Committee on Finance.

Finance Committee

February 13, 2019

Bill Text

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Introduced in SenateIssued February 13, 2019

II

116th CONGRESS

1st Session

S. 475

IN THE SENATE OF THE UNITED STATES

February 13, 2019

Mr. Wyden (for himself, Mr. Bennet, Mr. Cardin, Ms. Klobuchar, Mr. Merkley, and Mr. Whitehouse) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to prevent catastrophic out-of-pocket spending on prescription drugs for seniors and individuals with disabilities.

1.

Short title

This Act may be cited as the Reducing Existing Costs Associated with Pharmaceuticals for Seniors Act of 2019 or the RxCAP Act of 2019.

2.

Elimination of cost-sharing above the Medicare part D annual out-of-pocket threshold

(a)

In general

Section 1860D–2(b)(4)(A) of the Social Security Act (42 U.S.C. 1395w–102(b)(4)(A)) is amended—

(1)

in clause (i)—

(A)

by redesignating subclauses (I) and (II) as items (aa) and (bb), respectively, and indenting appropriately;

(B)

by striking subparagraph (B), with cost-sharing and inserting the following: “subparagraph (B)—

(I)

for plan years 2006 through 2019, with cost-sharing

;

(C)

in item (bb), as redesignated by subparagraph (A), by striking the period at the end and inserting ; and; and

(D)

by adding at the end the following new subclause:

(II)

for plan year 2020 and subsequent plan years, without any cost-sharing.

; and

(2)

in clause (ii)—

(A)

by striking clause (i)(I) and inserting clause (i)(I)(aa); and

(B)

by adding at the end the following new sentence: The Secretary shall continue to calculate the dollar amounts specified in clause (i)(I)(aa), including with the adjustment under this clause, after plan year 2019 for purposes of 1860D–14(a)(1)(D)(iii)..

(b)

Conforming amendments to low-Income subsidy

Section 1860D–14(a) of the Social Security Act (42 U.S.C. 1395w–114(a)) is amended—

(1)

in paragraph (1)—

(A)

in subparagraph (D)(iii), by striking 1860D–2(b)(4)(A)(i)(I) and inserting 1860D–2(b)(4)(A)(i)(I)(aa); and

(B)

in subparagraph (E)—

(i)

in the heading, by inserting prior to the elimination of such cost-sharing for all individuals after threshold; and

(ii)

by striking The elimination and inserting For plan years 2006 through 2019, the elimination; and

(2)

in paragraph (2)(E)—

(A)

in the heading, by inserting prior to the elimination of such cost-sharing for all individuals after threshold;

(B)

by striking Subject to and inserting For plan years 2006 through 2019, subject to; and

(C)

by striking 1860D–2(b)(4)(A)(i)(I) and inserting 1860D–2(b)(4)(A)(i)(I)(aa).