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The bill makes prescription costs more immediately affordable and predictable for patients who pay cash or use coupons by counting those payments toward deductibles and out-of-pocket limits, but it shifts costs and incentives onto insurers, employers, and manufacturers in ways that could raise premiums, employer costs, or drug prices.
Patients who pay cash for prescriptions or use manufacturer coupons (especially people with chronic conditions who face high drug costs) will have those payments count toward their plan deductibles and out-of-pocket maximums, reducing future cost-sharing and making expensive drugs more immediately affordable and predictable.
Medicaid and other federal program spending is less likely to be distorted by manufacturer cash-purchase discounts because those discounts can be excluded from "best price"/AMP calculations, helping stabilize federal drug rebate calculations and program budgets.
Health plans and insurers will face higher cost exposure if more cash payments count toward plan limits, which can lead to higher premiums, stricter benefit designs, or greater cost-shifting to consumers and taxpayers over time.
Employers that sponsor group health plans (including small businesses) could see higher plan costs and contributions, possibly increasing employer-sponsored premiums or reducing other employee benefits.
Drug manufacturers may lose leverage to target discounts tied to insurer benefit designs and could respond by raising list prices, changing discount strategies, or reducing patient assistance in ways that increase drug costs for some patients.
Based on analysis of 2 sections of legislative text.
Requires cash purchases of prescription drugs to count toward plan deductibles and out‑of‑pocket maximums and excludes those cash prices from Medicaid "best price" calculations.
Official title: To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require out-of-pocket expenditures for drugs to count towards an individual's deductible and out-of-pocket maximum.
Introduced April 14, 2026 by Gregory Francis Murphy · Last progress April 14, 2026
Requires health plans and issuers to count a patient’s out‑of‑pocket cash purchase of a prescription drug toward that plan’s deductible and out‑of‑pocket maximum, even when the patient declines to use available plan benefits. Also amends Medicaid drug‑pricing rules to ensure those cash purchases are excluded from "best price" and average manufacturer price calculations. Applies these requirements across the Public Health Service Act, ERISA plans, and the Internal Revenue Code, with implementation for plan years beginning on or after January 1, 2027.