H.R. 8270

119 HR 8270 IH: Every Dollar Counts Act of 2026
 U.S. House of Representatives
 2026-04-14
 text/xml
 EN
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 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.