Workers are increasingly turning to direct-to-consumer online drug platforms (like Amazon Pharmacy, Mark Cuban Cost Plus Drug Company and the government-backed TrumpRx) to buy prescription medications at lower prices — but those prescription drug costs often do not count toward their health plan deductible or out-of-pocket maximum.
A new bill in Congress aims to change that. The Every Dollar Counts Act, introduced by Rep. Greg Murphy (R-North Carolina), would require health insurers to apply out-of-pocket spending on covered prescription drugs toward a patient’s deductible and out-of-pocket maximum regardless of where the drugs were purchased.
Murphy is a physician and longtime critic of insurers and pharmacy benefit managers. He stated the legislation is designed to remove barriers that discourage patients from using lower-cost prescription drug options.
Proposed Legislation Changes Health Plans
Direct-to-consumer drug platforms have gained traction by bypassing some traditional distribution channels and offering discounted pricing. Particularly for certain brand-name medications.
The issue has drawn additional attention following the White House-backed launch of TrumpRx earlier this year. The program seeks to negotiate lower drug prices directly with manufacturers.
Supporters of the legislation argue that the current system can effectively force patients to “pay twice.” A worker might save money by purchasing a medication through a low-cost online platform. But, those expenditures often do not help satisfy the plan deductible unless the drug is purchased through a plan-approved pharmacy or pharmacy benefit manager network.
How This Affects Prescription Drug Costs and Health Plans
For employers, the proposal highlights a growing tension in prescription drug benefits. On one hand, allowing employees to use lower-cost purchasing options could reduce out-of-pocket expenses. It could also improve medication adherence. Employees who can afford their medications are more likely to stay on treatment and avoid costlier health complications later.
On the other hand, some employers and health plans may worry that the bill could weaken cost-management strategies tied to network pharmacies, formularies and benefit design. Health plans often use deductibles, copayments and preferred pharmacy arrangements to steer participants toward negotiated pricing and control overall drug spending.
The debate could shape how workers access lower-cost medications. As well as how health plans balance affordability with efforts to manage overall drug spending.
