Summary of HR 8270 (119th Congress) – Every Dollar Counts Act of 2026

Goal: The bill aims to ensure that out-of-pocket expenditures for drugs count toward an individual’s deductible and out-of-pocket maximum (OOPM) across certain health coverage frameworks.

1) Purpose and intent

• Establishes that certain drug-related out-of-pocket payments should be counted toward:
  • an individual’s deductible
  • the plan's out-of-pocket maximum
• Applies to both group health plans and health insurance issuers offering group or individual coverage.
• Sections cover three major baseline health policy regimes: Public Health Service Act (PHSA), Employee Retirement Income Security Act (ERISA), and Internal Revenue Code (IRC).

2) Key provisions and changes

A. Public Health Service Act (PHSA)

• Adds a new Sec. 2799A–11.
• Requirement: For individuals who elect to purchase a drug with available benefits under their plan but without applying those benefits, their out-of-pocket expenditures for that drug count toward the deductible and OOPM that would have applied if they had applied benefits.

B. ERISA

• Adds a new Sec. 726.
• Requirement: For participants/beneficiaries who elect to purchase a drug with available benefits under their plan but without applying those benefits, their out-of-pocket expenditures count toward the deductible and OOPM that would have applied.
• Technical change: Updates the ERISA table of contents to reflect the new Sec. 726.

C. Internal Revenue Code (IRC)

• Adds a new Sec. 9826.
• Requirement: For individuals enrolled in a group health plan who elect to purchase a drug without applying plan benefits, count their out-of-pocket expenditures toward the deductible and OOPM that would have applied if benefits were applied.
• Technical change: Updates the tax code table of sections to include Sec. 9826.

D. Conforming and related amendments (SS Act and other price measures)

• Adjusts related provisions to align with the counting requirement, including:
  • Adjustments to best price calculations under the Social Security Act (SSI-linked programs) to exclude price reductions when individuals purchase drugs without applying benefits under a group or individual plan or federal programs.
  • Aligns average manufacturer price (AMP) calculations to include reductions in price when individuals purchase drugs without applying benefits under a plan or federal programs.
• These adjustments ensure price reporting and adjustments do not undermine the counting of out-of-pocket drug expenditures toward deductibles/OOPMs.

E. Effective date

• Applies to plan years beginning on or after January 1, 2027.

3) Who would be affected

• Individuals enrolled in:
  • Group health plans
  • Health insurance issuers offering group or individual coverage
• Those who choose to purchase drugs that have plan benefits available but opt not to apply those benefits at the time of purchase.
• Affected entities include:
  • Employers sponsoring group health plans
  • Health insurers and plan administrators
  • Tax-exempt and for-profit entities administering ERISA plans

4) Timeline and procedural notes

• Introduction date: April 14, 2026.
• Referred to multiple committees: Energy and Commerce; Education and Workforce; Ways and Means.
• Effective date for core provisions: Plan years beginning on or after January 1, 2027.
• The bill requires regulatory or administrative alignment across PHSA, ERISA, and the IRC with corresponding conforming amendments to related statutes.

5) Observations for readers

• The policy shift is consumer-protection oriented: it ensures that drug spending contributes to the financial protection provided by deductibles and OOPMs, potentially reducing the net out-of-pocket burden when patients choose to pay for drugs out-of-pocket rather than applying plan benefits.
• The bill creates cross-cutting amendments across health, employment, and tax statutes to implement a unified counting rule for out-of-pocket drug expenditures.
• It includes price reporting adaptations to maintain consistency with the new counting approach and to safeguard program integrity.

If you’d like, I can provide a section-by-section line-item mapping or an impact assessment for employers, insurers, or patients.