Rep. Greg Murphy (R-North Carolina) introduced the law Every dollar counts Tuesday. This would ensure that out-of-pocket costs for covered prescription drugs are applied to patient deductibles and out-of-pocket maximum limits, regardless of where the drugs are purchased.
More and more patients are relying on direct-to-consumer platforms to access prescription medications. These platforms include Eli Lilly’s LillyDirect or Novo Nordisk’s NovoCare, as well as telehealth platforms like Hims & Hers and Ro. Direct-to-consumer platforms can reduce direct drug costs by cutting out prescription drug middlemen, according to Murphy’s announcement.
However, many health insurance plans do not apply out-of-pocket costs to patients’ deductibles or out-of-pocket limits unless the drug is obtained through the plan’s designated channels. This leads to patients often having to “pay twice” and facing more “financial burden, fragmented access, delays in care and market distortion,” the statement said.
This is what the bill seeks to change.
“Direct-to-patient platforms have the potential to radically transform the drug market, putting much-needed downward pressure on the extraordinary cost of life-saving medications. However, the patients who will benefit the most cannot apply their spending on drugs purchased through these platforms to their health insurance direct contribution requirements. By making this possible, we are putting patients first and promoting competition to further reduce costs,” Murphy said in a statement. He is also a practicing surgeon.
The Council for Affordable Health Coverage applauded the bill. CAHC is an advocacy organization that aims to reduce the cost of health care.
“Affordability is Americans’ number one concern,” said Joel White, president of the Council for Affordable Health Coverage. “In health care, it determines whether patients can get the medications and care they need to stay healthy. Congressman Murphy’s legislation helps eliminate barriers to that care and improve health outcomes.”
The introduction of the Every Dollar Counts Act comes after the Trump administration launched its own direct-to-consumer drug platform called TrumpRx in February. It offers discounted cash prices for certain brand-name prescription drugs and is available to consumers who do not use insurance.
However, patients cannot purchase medications directly from TrumpRx. Instead, the platform connects them to drug manufacturer websites or provides coupons to retail pharmacies.
Photo: z_wei, Getty Images
