Insurers May Soon Have to Count Your $15 Cash-Pay Drug Purchase Toward Your Deductible

Paying $15 in cash for a prescription that costs $1,500 through insurance should count toward your deductible — and soon, it might. Under a new plan from Rep. Greg Murphy (R-N.C.), commercial insurers would be required to apply cash-pay prescription drug purchases toward patients’ deductibles and out-of-pocket maximums, a move that could reshape how millions track their health care spending.

Murphy, a practicing surgeon and co-chair of the GOP Doctors Caucus, said he was prompted by a patient paying $1,500 a month for medication available on a cash-pay platform for $15. That patient got no credit toward meeting their deductible despite spending out of pocket. “He should be able to take that $15 and say, I paid out of my pocket for this medication, and I am insured by this insurance company. It should go toward my deductible,” Murphy said.

Today, patients who use platforms like TrumpRx or Mark Cuban’s CostPlusDrugs often save money upfront but lose the long-term benefit of progress toward insurance coverage kicking in. The discrepancy is especially acute for people in high-deductible health plans, who must pay thousands out of pocket before full benefits activate.

The legislation would only allow credit if the drug is on a patient’s plan’s formulary. It does not apply to Medicare or Medicaid. But for commercial plans, the change could incentivize price transparency and direct-to-consumer purchasing.

The shift already has momentum. Express Scripts, one of the nation’s largest pharmacy benefit managers, agreed in a settlement with the Federal Trade Commission to count TrumpRx purchases toward deductibles by 2027. Details remain unclear, including how insurers would verify purchases. CVS Health CEO David Joyner said the company would adopt similar policies if they lower costs for Americans.

Still, there’s a trade-off. Requiring insurers to credit cash payments could lead to higher premiums, warned Benjamin Rome, a Harvard drug pricing researcher. “If you’re going to put additional requirements on insurers on how they’re going to set their benefit design, that does have consequences,” he said. “It might be totally reasonable to do that — it just is not free.” The growing bipartisan push to lower drug costs may give Murphy’s bill traction, especially as affordability becomes a central midterm election issue.