Rep. Greg Murphy (R-North Carolina) introduced the Every Dollar Counts Act on Tuesday. It would ensure out-of-pocket costs for covered prescription drugs are applied toward patients’ deductibles and maximum out-of-pocket limits, no matter where the drugs are purchased.
More and more patients are relying on direct-to-consumer platforms to access prescription drugs. These platforms include Eli Lilly’s LillyDirect or Novo Nordisk’s NovoCare, as well as telehealth platforms like Hims & Hers and Ro. Direct-to-consumer platforms can lower out-of-pocket drug costs by cutting out prescription drug middlemen, according to Murphy’s announcement.
However, many health plans do not apply out-of-pocket spending toward patients’ deductibles or out-of-pocket limits unless the drug is obtained through designated plan channels. This leads to patients often having to “pay twice” and facing more “financial burden, fragmented access, delayed care, and market distortion,” the announcement stated.
That is what the bill seeks to change.
“Direct-to-patient platforms have the potential to radically transform the drug marketplace, applying much-needed downward pressure on the extraordinary cost of lifesaving medicines. However, patients who are set to benefit most cannot apply their expenditures on drugs purchased through these platforms to their health insurance out-of-pocket contribution requirements. By making this possible, we are putting patients first and promoting competition to drive down costs further,” Murphy said in a statement. He is also a practicing surgeon.
The Council for Affordable Health Coverage applauded the bill. CAHC is an advocacy organization focused on bringing down the cost of healthcare.
“Affordability is the defining concern for Americans,” said Joel White, president of the Council for Affordable Health Coverage. “In health care, it determines whether patients can get the medicines and care they need to stay healthy. Congressman Murphy’s legislation helps remove barriers to that care and improve health outcomes.”
The introduction of the Every Dollar Counts Act comes after the Trump administration launched its own direct-to-consumer drug platform called TrumpRx in February. It offers discounted cash prices for certain brand-name prescription drugs and is available to consumers who are not using insurance.
However, patients can’t directly purchase medications on TrumpRx. Instead, the platform connects them to drug manufacturer websites or provides coupons for retail pharmacies.
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