New House Bill Would Require Insurers to Count Direct-to-Consumer Drug Purchases

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

A bill introduced by Representative Greg Murphy, M.D. (R-NC-03), would require insurers to count the cost of prescription medications purchased through direct-to-consumer platforms, such as the TrumpRX website (Hopkins, 2026), toward both deductibles and out-of-pocket maximums (Minemeyer, 2026).

Photo Source: Rep. Greg Murphy

The "Every Dollar Counts Act" (H.R. 8270), introduced in April 2026, would amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Service Code of 1986 to require out-of-pocket expenditures for drugs to count towards an individual’s deductible and out-of-pocket maximums. It does come with some caveats:

To count, the medication must be on the individual’s health plan’s formulary, meaning it would otherwise be covered by the insurance plan with a co-pay (Goldman, 2026).

"Direct-to-patient platforms have the potential to radically transform the drug marketplace, applying much-needed downward pressure on the extraordinary cost of lifesaving medicines. However, patients who are set to benefit most cannot apply their expenditures on drugs purchased through these platforms to their health insurance out-of-pocket contribution requirements. By making this possible, we are putting patients first and promoting competition to drive down costs further" (Murphy, 2026).

Photo Source: Congress.gov

Direct-to-consumer/patient platforms are becoming increasingly common since 2024, with numerous pharmaceutical companies and organizations, including Amgen (maker of Repatha), Eli Lilly (Zepbound), Novo Nordisk (Wegovy), Pfizer (Eliquis), AstraZeneca (Farxiga), Novartis (Cosentyx), Bristol Myers Squibb (Sotyktu), and PhRMA, the U.S. pharmaceutical lobbying group based in Washington, DC, going live with websites offering medications directly to patients, often at lower prices than what they would pay when using their commercial insurance (Constantino & Coombs, 2025).

The concept of direct-to-consumer sales isn’t new; but in an age when almost every medication purchase (in the United States) goes through complex chains of manufacturers, wholesalers, pharmacy benefits managers (PBMs), and pharmacies that then get filtered through another round of payors (e.g., commercial and public health insurers), consumers often have little idea of the true cost of their medications. More to the point, tiered prescription co-pays and the availability of manufacturer and commercial drug coupons, such as manufacturer patient assistance programs (PAPs) and GoodRx, make it difficult for patients to make informed decisions about the most affordable way to obtain their medications.

Patients have been sharing their stories on social media and in the press with their anecdotal encounters where they face a high-dollar sticker shock at the pharmacy register, only for their pharmacist to scan a different barcode behind the counter and come back with a significantly lower dollar amount (Fottrell, 2026).

Photo Source: Elements Magazine

GoodRx, founded in 2011, provides patients with a relatively easy-to-use website and smart phone app that allows patients to explore drug prices at various local pharmacies based on zip code. They also offer a subscription service, GoodRx Companion, that offers low-cost medications and savings on various medical services (GoodRx, 2026).

For consumers, this may seem like insurance, but GoodRx is quick to remind patients at every step that it is not health insurance; it is a collection of co-pay assistance coupons.

And this is the rub for many consumers: if they can get their prescription drugs this cheaply by scanning a QR Code, why should they ever have to pay a higher price?

This is an excellent question.

Why should American consumers be required to pay higher prices than any other nation for medications (Editor’s Note: Asking this question is not an endorsement of the deeply flawed Most Favored Nations proposed policy change)? Why should American consumers have copay accumulator programs that prohibit patient assistance program assistance from counting toward their deductibles? Why should American consumers be held captive in an endless labyrinth of ever-changing co-pays, surprise bills, and coverage denials for medications listed as being “covered”?

The answer is simple: because the “system” allows it.

Disclaimer: All funders of the ADAP Advocacy Association are publicly listed on our website. 

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association; rather, they provide a neutral platform for the author to promote open, honest discussion of public health-related issues and updates.

References:

[1] Constantino, A. K. & Coombs, B. (2025, October 07). Healthy Returns: Amgen joins a growing list of drugmakers selling directly to consumers. Englewood Cliffs, NJ: CNBC: Health Returns. https://www.cnbc.com/2025/10/07/healthy-returns-amgen-other-drugmakers-launch-dtc-programs.html

[2] Every Dollar Counts Act, The, H.R. 8270, 119th Cong. (2026). https://www.congress.gov/bill/119th-congress/house-bill/8270

[3] Fottrell, Q. (2026, June 23). ‘It feels like a medical miracle’: How did a single QR code coupon cut my $618 Walgreens prescription to $15? New York, NY: MarketWatch: Personal Finance: The Moneyfist. https://www.marketwatch.com/story/it-feels-like-a-medical-miracle-how-did-a-single-qr-code-coupon-cut-my-618-walgreens-prescription-to-15-524a1151

[4] Goldman, M. (2026, April 14). Exclusive: GOP pushes sweetener for cash-pay drugs. Arlington, VA: Axios: Health. https://www.axios.com/2026/04/14/gop-cash-pay-drug-deductible

[5] GoodRx. (2026). GoodRx Companion. Santa Monica, CA: GoodRx: Companion. https://www.goodrx.com/companion

[6] Hopkins, M. J. (2026, January 22). Trump Administration Applauds Itself for Rx Access Agreements, But Will They Help Patients? Nags Head, NC: ADAP Advocacy: ADAP Blog. https://adapadvocacyassociation.blogspot.com/2026/01/trump-administration-applauds-itself.html

[7] Minemeyer, P. (2026, April 14). Bill would force payers to apply DTC drug purchases to patient deductibles. New York NY: Fierce Healthcare: Regulatory. https://www.fiercehealthcare.com/regulatory/bill-seeks-force-payers-apply-dtc-drug-purchases-patient-deductibles

[8] Murphy, G. F. (2026, April 14). Murphy Introduces Legislation to Lower Out-of-Pocket Costs for Drugs. Mantea, NC: U.S. Congressman Gregory F. Murphy, M.D.: Media: Press Releases. https://murphy.house.gov/media/press-releases/murphy-introduces-legislation-lower-out-pocket-costs-drugs