Section 1 Short title
This Act may be cited as the “Every Dollar Counts Act of 2026”.
Every Dollar Counts Act of 2026
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.
Sec. 2 Requiring out-of-pocket expenditures for drugs to count towards an individual’s deductible and out-of-pocket maximum
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:
“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.”
ERISA—
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:
“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.”
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:
IRC—
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:
“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.”
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:
Conforming amendments—
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—
in subclause (IV), by striking “and” at the end;
in subclause (V), by striking the period at the end and inserting “; and”; and
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).”
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—
in subclause (VII), by striking “and” at the end;
in subclause (VIII), by striking the period at the end and inserting “; and”; and
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).”
Effective date— The amendments made by subsections (a) through (c) shall apply with respect to plan years beginning on or after January 1, 2027.