H.R. 8270

[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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