Under the Every Dollar Counts Act, introduced recently by Rep. Greg Murphy (R-N.C.), out-of-pocket spending for covered drugs would count toward a patient’s maximum out-of-pocket and deductible regardless of where such drugs are purchased.
“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,” he 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.”
See also: This HR leader is on a ‘mission’ to give employees a voice
Murphy, a urologist, is one of 19 physicians currently serving in Congress. Before entering politics, he was president of a medical practice, chief of staff of a medical center and a member of the medical school faculty at East Carolina University.
Patients increasingly rely on a range of options to access prescription medications, including direct-to-patient platforms, according to a news release from his congressional office. These have emerged as a source for lower prescription drug costs by cutting out the middlemen. Such platforms can substantially lower out-of-pocket costs for patients, especially for high-cost, brand-name drugs.
However, many health plans do not count out-of-pocket spending toward a patient’s deductible or out-of-pocket limit unless the drug is purchased specifically through plan-designated channels. This existing framework may force patients to “pay twice” and lead to higher financial burden, fragmented access, delayed care and market distortion. The proposed policy closes a gap in the law to ensure patients receive full credit for what they spend on needed medications.
Joel White, president of the Council for Affordable Health Coverage, supports the bill.
“Affordability is the defining concern for Americans,” he said. “In healthcare, 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.”
However, although the bill could help workers minimize their out-of-pocket spending, it also could complicate efforts by employers to hold down overall plan spending by limiting their ability to use strategies such as deductibles and copayment levels to reduce plan participants’ use of very expensive drugs.
The launch of TrumpRx earlier this year drew more attention to direct-to-consumer drug platforms. President Donald Trump has used the platform to negotiate several deals with leading drugmakers that provide most-favored nation pricing for certain drugs. Murphy consulted with the White House about his bill, according to Axios.
Credit: Source link
