A few weeks ago, we shared an overview of TrumpRx (available here).
Since then, the program has grown from 43 drugs to over 61, with companies like AbbVie and Genentech joining the site. AbbVie will sell its arthritis drug Humira, which is also used to treat Crohn’s disease and ulcerative colitis, and Genentech will offer its flu treatment Xofluza, both at discounted prices.
As was the case with the original 43 drugs, these prices are available only for cash-paying individuals, meaning they cannot be purchased through one’s insurance, and health experts have stressed that insurance coverage may still provide a lower price.
Currently, any amount paid for medications through TrumpRx does not count toward a patient’s deductible or out-of-pocket maximum. However, some policymakers are seeking to change that.
On April 14, Congressman Greg Murphy, M.D. (R-NC) introduced the Every Dollar Counts Act. The legislation would require that out-of-pocket spending on covered drugs count toward a patient’s deductible and out-of-pocket maximum, regardless of where such drugs are purchased.
Deductibles and out-of-pocket maximums are both thresholds that patients must cross in order for their insurance company to pick up the tab. A deductible is the amount a patient must pay before insurance begins covering a share of costs, while the out-of-pocket maximum is the total amount a patient will pay in a year before insurance covers 100% of eligible healthcare expenses.
The legislation was drafted on the belief that direct-to-consumer platforms, like TrumpRx, “have the potential to radically transform the drug marketplace, applying much-needed downward pressure on the extraordinary cost of lifesaving medicines,” but that impact may be limited if patients cannot apply their spending toward their deductible or out-of-pocket maximum.
The bill would only apply to commercial insurers, and drugs would need to be included on a plan’s formulary, or list of drugs covered, to actually count toward either threshold. It would include other cash-pay platforms like Mark Cuban’s CostPlusDrugs, and could be beneficial to the rising number of Americans on high-deductible health plans.
The Infusion Access Foundation supports efforts that allow patients to count these expenditures toward their deductible and out-of-pocket maximums, as they could provide greater flexibility and potential savings for patients. However, requiring these changes could also have unintended consequences. Health plans may argue that these requirements increase costs, which could ultimately result in higher premiums for consumers.
At the same time, we are encouraged by continued bipartisan attention to healthcare affordability and ongoing concerns about consolidation and vertical integration in the healthcare system. Representative Murphy has expressed that he plans to keep the pressure on with another bill to be introduced soon, stating,
“[w]e’re going to…basically run the gamut to see which one has the greatest chance of being passed.”