The IRS has announced that the applicable dollar amount used to calculate the fees imposed by Code Secs. 4375 and 4376 for policy and plan years that end on or after October 1, 2025, and before October 1, 2026, is $3.84. This figure is based on the percentage increase in the projected per capita amount of the National Health Expenditures published by HHS on June 24, 2025.
Calculation
The fees, used to fund the Patient-Centered Outcomes Research Trust Fund (PCORTF), are generally calculated by multiplying the average number of lives covered under the health insurance policy or self-insured health plan by the adjusted applicable dollar amount. The adjusted applicable dollar amount is the sum of:
- the applicable dollar amount for the policy year or plan year ending in the previous federal fiscal year; plus
- the amount equal to the product of the applicable dollar amount for the policy year or plan year ending in the previous federal fiscal year; and the percentage increase in the projected per capita amount of the National Health Expenditures most recently released by the Department of Health and Human Services (HHS) before the beginning of the federal fiscal year (see Reg. §46.4375-1(c)(4) and Reg. §46.4376-1(c)(3)).
The applicable dollar amount for the previous year was $3.47.
