Every Dollar Counts Act of 2026

This legislation aims to ensure that all out-of-pocket drug costs incurred by individuals are credited towards their health plan's deductible and annual out-of-pocket maximum. This applies even when an individual chooses to purchase a drug for which benefits are available without directly applying those benefits at the point of sale, thereby providing financial relief by ensuring all drug costs contribute to annual out-of-pocket limits. The bill achieves this by amending three significant federal statutes: the Public Health Service Act , the Employee Retirement Income Security Act of 1974 (ERISA) , and the Internal Revenue Code of 1986 . These amendments specifically require group health plans and health insurance issuers to count such expenditures towards an individual's financial responsibility thresholds. Furthermore, the bill includes conforming amendments to the Social Security Act, which are crucial for drug pricing calculations. These changes ensure that any price reductions obtained by individuals purchasing drugs without using their insurance benefits are excluded from the "best price" and "average manufacturer price" calculations used for federal programs like Medicaid. This prevents these individual transactions from inadvertently lowering the benchmark prices for government drug purchases. The provisions of this act are set to take effect for plan years beginning on or after January 1, 2027, providing a clear timeline for implementation.