Rep. Greg Murphy, MD, R-N.C., has introduced a bill that would require out-of-pocket expenditures for drugs to count toward a patient’s maximum out-of-pocket and deductible.
Patients are increasingly getting prescription medications through direct-to-patient platforms that offer lower out-of-pocket costs, especially for high-cost, brand-name drugs, according to an April 14 news release. However, many health plans do not count this spending toward the patients’ deductible unless the drug is purchased on a plan-designated channel. This framework requires patients to “pay twice,” and can result in delayed care and access.
The Every Dollar Counts Act aims to close the gap by ensuring patients receive credit for what they spend on medications.
“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,” Mr. Murphy said. “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.”
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.