Every Dollar Counts Act of 2026

119 HR 8270 IH: Every Dollar Counts Act of 2026 U.S. House of Representatives 2026-04-14 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. I 119th CONGRESS 2d Session H. R. 8270 IN THE HOUSE OF REPRESENTATIVES April 14, 2026 Mr. Murphy (for himself, Mr. Moore of Utah , Mr. Barrett , Mr. Edwards , and Ms. Tenney ) introduced the following bill; which was 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 A BILL 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. 1. Short title This Act may be cited as the Every Dollar Counts Act of 2026 . 2. Requiring out-of-pocket expenditures for drugs to count towards an individual’s deductible and out-of-pocket maximum (a) PHSA Part D of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–111 et seq. ) is amended by adding at the end the following new section: 2799A–11. Counting out-of-pocket expenditures for certain drugs towards a deductible and out-of-pocket maximum A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, in the case of an individual enrolled under such plan or coverage who elects to purchase a drug for which benefits are available under such plan or coverage without applying such benefits, count any out-of-pocket expenditures incurred by such individual with respect to such drug towards any deductible and out-of-pocket maximum that would have applied had such individual applied such benefits. . (b) ERISA (1) In general Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185 et seq. ) is amended by adding at the end the following new section: 726. Counting out-of-pocket expenditures for certain drugs towards a deductible and out-of-pocket maximum A group health plan and a health insurance issuer offering group health insurance coverage shall, in the case of a participant or beneficiary enrolled under such plan or coverage who elects to purchase a drug for which benefits are available under such plan or coverage without applying such benefits, count any out-of-pocket expenditures incurred by such participant or beneficiary with respect to such drug towards any deductible and out-of-pocket maximum that would have applied had such participant or beneficiary applied such benefits. . (2) Clerical amendment The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1001 note) is amended by inserting after the item relating to section 725 the following new item: Sec. 726. Counting out-of-pocket expenditures for certain drugs towards a deductible and out-of-pocket maximum. . (c) IRC (1) In general Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section: 9826. Counting out-of-pocket expenditures for certain drugs towards a deductible and out-of-pocket maximum A group health plan shall, in the case of an individual enrolled under such plan who elects to purchase a drug for which benefits are available under such plan without applying such benefits, count any out-of-pocket expenditures incurred by such individual with respect to such drug towards any deductible and out-of-pocket maximum that would have applied had such individual applied such benefits. . (2) Clerical amendment The table of sections for subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item: Sec. 9826. Counting out-of-pocket expenditures for certain drugs towards a deductible and out-of-pocket maximum. . (d) Conforming amendments (1) Best price Section 1927(c)(1)(C)(ii) of the Social Security Act ( 42 U.S.C. 1396r–8(c)(1)(C)(ii) ) is amended— (A) in subclause (IV), by striking and at the end; (B) in subclause (V), by striking the period at the end and inserting ; and ; and (C) by adding at the end the following new subclause: (VI) shall exclude any reduction in price with respect to an individual purchasing such drug without applying any benefits under a group health plan (as defined in section 2791 of the Public Health Service Act), group or individual health insurance coverage (as so defined), or a Federal health care program (as defined in section 1128B but including the program established under chapter 89 of title 5, United States Code). . (2) Average manufacturer price Section 1927(k)(1)(B)(i) of the Social Security Act ( 42 U.S.C. 1396r–8(k)(1)(B)(i) ) is amended— (A) in subclause (VII), by striking and at the end; (B) in subclause (VIII), by striking the period at the end and inserting ; and ; and (C) by adding at the end the following new subclause: (IX) any reduction in price with respect to an individual purchasing such drug without applying any benefits under a group health plan (as defined in section 2791 of the Public Health Service Act), group or individual health insurance coverage (as so defined), or a Federal health care program (as defined in section 1128B but including the program established under chapter 89 of title 5, United States Code). . (e) Effective date The amendments made by subsections (a) through (c) shall apply with respect to plan years beginning on or after January 1, 2027.