[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8270 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 8270
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.
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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
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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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Every Dollar Counts Act of 2026''.
SEC. 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:
``SEC. 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:
``SEC. 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:
``SEC. 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.
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