Patients shouldn’t be penalized for finding a better deal on their prescriptions.
Too often, they are.
Those who pay out of pocket for medications — often at lower prices through direct-to-consumer platforms — typically receive no credit toward their health plan’s annual deductible. Higher-priced drugs purchased through an insurer’s preferred channels, on the other hand, do count.
CORPORATE HOSPITALS ARE DRIVING UP HEALTHCARE COSTS FOR THE REST OF US
That makes little sense. A new bill from Rep. Greg Murphy (R-NC) aims to fix that inequity. His Every Dollar Counts Act would require insurers to count out-of-pocket spending on prescription drugs toward a patient’s deductible — including purchases made outside traditional insurance channels.
It’s a simple, pro-consumer reform with the potential to improve both costs and competition.
Start with fairness. A dollar spent on medication is a dollar spent, regardless of where the purchase occurs. There is no sound policy reason to punish patients for finding better deals outside their insurer’s network.
Yet, that is exactly what the current system does. By excluding out-of-pocket drug purchases from patients’ deductibles, insurers steer them toward pharmacies and pricing arrangements that often benefit the health plan, even when cheaper options are available elsewhere.
When most drug spending flows through insurance, patients rarely see the true cost of their medications. That makes it easier for middlemen, including pharmacy benefit managers, to inflate prices, negotiate opaque rebates, and take a cut with little scrutiny.
Murphy’s proposal would help change that.
By allowing patients to count direct purchases toward their deductible, the bill would put transparent, cash-based drug markets on a more equal footing with the insurance-driven system. That could make lower-cost options, including those offered by emerging direct-to-consumer platforms, more attractive.
The bill would also help patients reach their deductibles faster, ensuring that catastrophic coverage kicks in when it is supposed to — after meaningful out-of-pocket spending.
Patients would gain more control and better incentives to seek value without new mandates, massive spending, or bureaucratic complexity.
HOSPITALS ARE A PRIME SUSPECT IN THE AFFORDABILITY CRISIS
As lawmakers look for ways to make healthcare more affordable, they should not overlook reforms like this one. Sometimes, the most effective solutions are not sweeping overhauls but targeted fixes that restore basic market forces.
Empowering patients to shop for better deals and rewarding them when they do is a good place to start.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World’s Medicine Chest: How America Achieved Pharmaceutical Supremacy—and How to Keep It (Encounter 2025). Follow her on X @sallypipes.