Overview of the Every Dollar Counts Act
A new House bill could change how insurers treat drug purchases made outside traditional pharmacy channels. Rep. Greg Murphy, MD (R-NC), introduced the Every Dollar Counts Act on April 14, 2026. The legislation would require commercial insurers to count out-of-pocket spending on direct-to-consumer (DTC) drug platforms toward patients’ deductibles and out-of-pocket maximums (MOOPs). Currently, patients who purchase drugs through these platforms receive no credit toward their insurance cost-sharing thresholds — even when they pay entirely out of pocket.
Murphy, a practicing surgeon, argues that this gap creates a serious financial penalty. He recently treated a patient who paid $1,500 per month for a medication that was available on a cash-pay platform for just $15. “He should be able to take that $15 and say, I paid out of my pocket for this medication,” Murphy told Axios. His bill aims to close that loophole.
Why DTC Drug Platforms Are Gaining Ground
Lower Costs Through Direct Access
Direct-to-consumer and direct-to-patient (DTP) drug platforms are growing rapidly across the United States. These platforms — including Mark Cuban’s CostPlusDrugs, Eli Lilly’s LillyDirect, Novo Nordisk’s NovoCare, and telehealth platforms like Hims & Hers and Ro — connect patients directly with drug manufacturers or lower-cost dispensers. By cutting out pharmacy benefit managers (PBMs) and other intermediaries, they often deliver drugs at dramatically reduced prices, especially for brand-name medications.
A System Built for the Insured That Leaves Savers Behind
Despite these savings, a structural problem limits adoption. Insured patients who use DTC platforms to save money on a given purchase cannot apply that spending toward meeting their annual deductible or out-of-pocket maximum. As a result, many patients face a painful trade-off: save money today or make progress toward the insurance threshold that could reduce all their future costs. This discourages use of lower-cost options, even when those options are clearly cheaper.
How the Bill Would Work in Practice
Key Eligibility Requirements
The Every Dollar Counts Act sets a clear condition: a drug must appear on the patient’s health plan formulary to count toward the deductible. This means patients cannot claim credit for purchasing drugs that their insurer does not cover. Furthermore, the bill applies exclusively to commercial insurance plans — Medicare and Medicaid are not included in its scope.
Broad Platform Eligibility
Importantly, the bill is not limited to a single platform. It would apply to any qualifying DTC or DTP platform, including CostPlusDrugs, LillyDirect, NovoCare, and similar services. Patients, therefore, gain flexibility to shop across multiple platforms while still receiving deductible credit for their spending.
The TrumpRx Connection
The Every Dollar Counts Act arrives amid broader federal efforts to expand direct drug purchasing. The Trump administration launched TrumpRx in February 2026 — a platform offering discounted cash prices for certain brand-name prescription drugs. Rather than allowing direct purchases, TrumpRx directs consumers to manufacturer websites or retail pharmacy coupons. Separately, Express Scripts — one of the country’s largest PBMs — reached a settlement with the Federal Trade Commission requiring it to count TrumpRx purchases toward deductibles and out-of-pocket maximums by early 2027.
Murphy has also indicated plans to introduce a companion bill focused specifically on TrumpRx purchases. “We’re going to basically run the gamut to see which one has the greatest chance of being passed,” he said.
Industry Response: Supporters and Critics
Advocates Praise Patient-First Approach
The Council for Affordable Health Coverage (CAHC) voiced strong support for the legislation. “Affordability is the defining concern for Americans,” said CAHC President Joel White. “In health care, it determines whether patients can get the medicines and care they need to stay healthy. Congressman Murphy’s legislation helps remove barriers to that care and improve health outcomes.”
Insurers Remain Cautious
Not everyone shares that enthusiasm. Tina Stow, a spokesperson for the insurer trade group AHIP, said that for most Americans, the lowest drug prices come through their existing insurance coverage. “While brand drugmakers continue raising prices, health plans continue working to shield Americans from the full impact of those high and rising costs,” she stated. Insurers argue that counting DTC spending could complicate plan designs and create administrative burdens.
Why High-Deductible Plan Holders Stand to Gain Most
The Every Dollar Counts Act holds particular significance for the approximately half of Americans enrolled in high-deductible health plans (HDHPs). Under an HDHP, patients typically pay the full cost of drugs until their deductible is met. Moreover, they often pay list price, which can be far higher than available DTC cash prices. The ability to apply DTC spending toward their deductible would give HDHP enrollees a meaningful financial tool. They could save money on individual purchases while also making real progress toward full coverage benefits.
What Comes Next for the Legislation
Murphy has indicated he is seeking input from the White House and plans to position the Every Dollar Counts Act as part of a broader legislative package targeting drug affordability. Given bipartisan frustration with health care conglomerates and drug pricing, the bill may attract cross-party interest. Drug cost reduction is also shaping up as a key issue heading into the midterm election cycle. Whether the bill advances as a standalone measure or as part of a larger package remains to be seen — but its introduction signals growing legislative pressure on insurers to recognize how and where patients actually buy their medications.
