Workers are increasingly turning todirect-to-consumer online drug platforms like Amazon Pharmacy, Mark Cuban CostPlus Drug Company and the government-backed TrumpRx to buy prescriptionmedications at prices sometimes far lower than what they would pay throughtheir employer-sponsored health plans. But in many cases, the money they spendon those drugs does not count toward their health plan deductible or annualout-of-pocket maximum.
A new bill in Congress aims to change that. TheEvery Dollar Counts Act, introduced by Rep. Greg Murphy (R-North Carolina),would require health insurers to apply out-of-pocket spending on coveredprescription drugs toward a patient’s deductible and out-of-pocket maximumregardless of where the drugs were purchased.
Murphy, a physician and longtime critic of insurersand pharmacy benefit managers, said the legislation is designed to removebarriers that discourage patients from using lower-cost prescription drugoptions.
Direct-to-consumer drug platforms have gainedtraction by bypassing some traditional distributionchannels and offering discounted pricing, particularly for certain brand-name medications.The issue has drawn additional attention following the White House-backed launchof TrumpRx earlier this year, which seeks to negotiate lower drug prices directlywith manufacturers.
Supporters of the legislation argue that thecurrent system can effectively force patients to “pay twice.” Even ifa worker saves money by purchasing a medication through a low-cost onlineplatform, those expenditures often do not help satisfy the plan deductibleunless the drug is purchased through a plan-approved pharmacy or pharmacybenefit manager network.
For employers, the proposal highlights a growingtension in prescription drug benefits. On one hand, allowing employees to uselower-cost purchasing options could reduce out-of-pocket expenses and improvemedication adherence. Employees who can afford their medications are morelikely to stay on treatment and avoid costlier health complications later.
On the other hand, some employers and health plansmay worry that the bill could weaken cost-management strategies tied to networkpharmacies, formularies and benefit design. Plans often use deductibles,copayments and preferred pharmacy arrangements to steer participants towardnegotiated pricing and control overall drug spending.
The debate could shape how workers accesslower-cost medications and how health plans balance affordability with effortsto manage overall drug spending.