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The bill makes cash payments and coupons more immediately helpful to patients by counting them toward deductibles and OOP limits and protects federal rebate calculations, but it shifts cost risk onto insurers and employers and may prompt manufacturer price responses that could raise premiums or drug prices.
Patients who pay cash for prescription drugs—particularly people with chronic conditions—will have those payments count toward their insurance deductibles and out-of-pocket maximums, lowering their effective cost-sharing and reducing future expenses for high-cost drugs.
Consumers using manufacturer coupons or paying cash will see more predictable progress toward meeting deductibles and out-of-pocket maximums, improving affordability and adherence for people who need expensive medications.
Medicaid and other federal program drug spending may be protected from distortions to 'best price' and average manufacturer price (AMP) calculations by excluding cash-purchase discounts, helping stabilize rebate calculations and federal program budgets.
Health insurers and employer-sponsored plans could face higher cost exposure if more cash payments count toward limits, which may translate into higher premiums, larger employee contributions, or reduced benefits for enrollees.
Drug manufacturers may lose leverage tied to insurer benefit designs and could respond by raising list prices or changing discount strategies, potentially increasing drug costs for some patients and overall spending.
Employers that sponsor group health plans could see higher plan costs if more cash payments count toward deductibles and out-of-pocket maximums, which may increase employer contributions or lead to benefit changes.
Based on analysis of 2 sections of legislative text.
Requires cash drug purchases to be counted toward plan deductibles and out‑of‑pocket maxima and excludes such cash price reductions from Medicaid 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 group health plans and issuers to count a patient’s out‑of‑pocket cash purchase of a prescription drug toward the plan deductible and out‑of‑pocket maximum even when the patient chooses not to use available plan benefits. Also amends Medicaid drug pricing rules so that cash purchases made without applying plan or federal program benefits are excluded from manufacturer “best price” and average manufacturer price calculations. The rule applies to plan years beginning on or after January 1, 2027.