Every Dollar Counts Act of 2026
- Bill Number
- H.R. 8270
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-04-14: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-04-30T08:06:47Z
AI-Generated Summary
Purpose
The Every Dollar Counts Act of 2026 (H.R. 8270) aims to ensure that money patients pay out-of-pocket (OOP—costs not covered by insurance) for prescription drugs counts toward their health plan's deductible (amount paid before insurance kicks in) and out-of-pocket maximum (yearly cap on patient costs), even if they buy the drug without using insurance benefits. This applies to drugs covered by the plan.
Key Provisions
- Amendments to three major laws:
- Public Health Service Act (PHSA): Adds Section 2799A-11 requiring group health plans and insurers (for group or individual coverage) to credit OOP drug payments toward deductibles and OOP maximums.
- Employee Retirement Income Security Act (ERISA): Adds Section 726 with similar requirements for employer-sponsored group health plans.
- Internal Revenue Code (IRC): Adds Section 9826 applying the same rule to group health plans.
- Conforming changes to Medicaid drug pricing (Social Security Act):
- Excludes price reductions for drugs bought without using insurance benefits from best price and average manufacturer price calculations, which affect manufacturer rebates to Medicaid.
- Effective date: Applies to plan years starting on or after January 1, 2027.
Significant Changes to Existing Law
- Under current law, OOP payments for drugs made outside the insurance system (e.g., paying cash at a pharmacy) do not count toward deductibles or OOP maximums.
- This bill reverses that by mandating plans and insurers count such payments for covered drugs, promoting fairness in cost-sharing.
- Adjusts Medicaid rebate formulas to prevent drugmakers from using non-insurance discounts to lower rebate obligations.
Potential Impacts
- Citizens/patients: Reduces financial burden by accelerating progress toward deductibles/OOP caps, especially for those paying cash due to prior authorizations, network issues, or discounts; may lower total yearly drug costs.
- Health insurers and employers: Must update systems to track and apply these OOP credits, potentially increasing administrative costs but improving consumer satisfaction.
- Government agencies: Department of Health and Human Services (HHS), Labor, and Treasury enforce via existing frameworks; Medicaid may see stable or slightly higher rebates.
- No notable international relations impacts.
Main Stakeholders Affected
- Patients/enrollees in group or individual health plans.
- Health insurers and group health plan sponsors (e.g., employers).
- Drug manufacturers (via Medicaid pricing adjustments).
- Federal agencies overseeing health plans (HHS, DOL, IRS) and Medicaid.
Notable Legal, Constitutional, or Political Implications
- Legal: Harmonizes rules across PHSA, ERISA, and IRC for consistent enforcement; clerical amendments ensure clean integration into existing codes.
- Constitutional: None identified; builds on established federal authority over health insurance regulation.
- Political: Bipartisan sponsorship (Democrats and Republicans); addresses consumer complaints about "cash pay" penalties in high-deductible plans without mandating new spending.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Murphy, Gregory F. [R-NC-3]
Cosponsors (7)
Rep. Moore, Blake D. [R-UT-1], Rep. Barrett, Tom [R-MI-7], Rep. Edwards, Chuck [R-NC-11], Rep. Tenney, Claudia [R-NY-24], Rep. Pfluger, August [R-TX-11], Rep. Flood, Mike [R-NE-1], Rep. Harrigan, Pat [R-NC-10]
Recent Actions
- 2026-04-14: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-04-14: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-04-14: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-04-14: Introduced in House
- 2026-04-14: Introduced in House
Bill Versions
- Every Dollar Counts Act of 2026 — issued 2026-04-14 — PDF (6 pages)