Out-of-pocket drug costs would count toward insurance deductibles

What does this do?

This bill says that if you pay the full price for a prescription drug yourself instead of using your insurance, that spending still counts toward your deductible and out-of-pocket maximum. It also changes how two Medicaid drug-price calculations work so that cash-pay discounts are not included in those formulas. These rules would start with insurance plan years beginning on or after January 1, 2027.

Who does it affect?

People covered by employer health plans or individual health insurance would be affected. Medicaid drug-pricing rules would also change for drug manufacturers.

Why does it matter?

People who pay cash for a drug could reach their deductible or out-of-pocket cap sooner in years when they buy a drug without using their insurance. The Medicaid pricing changes would affect how certain drug discounts are counted in government calculations.

Where does it stand?