Murphy Introduces Legislation to Lower Out-of-Pocket Costs for Drugs

Washington, D.C. — Congressman Greg Murphy, M.D., introduced the Every Dollar Counts Act, legislation to require out-of-pocket expenditures for covered drugs to count towards the patient’s maximum out-of-pocket and deductible, regardless of where such drugs are purchased.

"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," said Congressman Greg Murphy, M.D. "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."

"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."

Background

• Patients increasingly rely on a range of options to access prescription medications, including direct-to-patient (DTP) platforms, which have emerged as a source for lower prescription drug costs by cutting out the middlemen.
• Such DTP platforms can substantially lower out-of-pocket costs for patients, especially for high-cost, brand-name drugs.
• However, many health plans do not count out-of-pocket spending towards patients’ deductible or out-of-pocket limit unless the drug is purchased specifically through plan-designated channels.
• This existing framework may force patients to “pay twice” and lead to higher financial burden, fragmented access, delayed care, and market distortion.
• This policy closes a gap in the law to ensure patients receive full credit for what they spend on needed medications.