Republicans in Congress are trying to attract more people to direct-to-consumer drug purchases on platforms like TrumpRx by requiring insurers to count that spending toward patients' deductibles and out-of-pocket limits.

Why it matters: Paying cash for drugs has limited appeal for insured patients, in part because it doesn't help them get to the point where insurance picks up a bigger portion of their health costs.

Driving the news: Rep. Greg Murphy (R-N.C.) is unveiling a plan today that would require commercial insurers to apply prescription drug purchases from cash-pay platforms toward deductibles and out-of-pocket maximums, he told Axios first.

• Murphy, a practicing surgeon, said he recently took care of a patient who was paying $1,500 a month for a medication that was available on a cash-pay site for $15.
• "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," said Murphy, who co-chairs the GOP Doctors Caucus.

Zoom in: The legislation would allow patients to take advantage of situations where a drug's cash price is lower than the cost through their health insurance.

• Drugs would have to be on a health plan's formulary to count toward a deductible. The bill doesn't apply to Medicare or Medicaid plans. It would work for platforms like Mark Cuban's CostPlusDrugs.

Between the lines: The change could be especially valuable to Americans with high-deductible health plans.

Reality check: Requiring cash-pay drugs to count toward a deductible could lead plans to raise their premiums, said Benjamin Rome, a Harvard drug pricing researcher and assistant professor of medicine.

• "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."

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Patients and clinicians are overturning more health insurer denials of medical services, mounting successful appeals more than half of the time last year, an analysis of 51,000 cases in New York state found.

Why it matters: Improper claim denials can cut off access to critical care and lead to more medical debt.

• Long-running efforts in Congress to address the issue in Medicare stalled earlier this year, when a measure on insurer reviews was left out of the health package that was folded into the latest government funding deal.

What they found: The percentage of insurer decisions overturned by external reviews in New York has increased steadily from 38% in 2019 to 52.5% in 2025, researchers wrote in JAMA Internal Medicine.

• The rates varied by treatments and diagnoses, with nearly 8 in 10 appeals for home health care and 61% of appeals for substance use or addiction services overturned.
• Reasons for denials included human or technological errors, outdated clinical criteria embedded in claims systems, ambiguous coverage rules and inappropriate insurer behavior.

Separately, research firm IQVIA reported that 70% of all attempts to fill a new branded medicine prescription through commercial insurance were initially denied coverage in 2025, up from 57% in 2021.

As many as 20% of postpartum deaths in the U.S. are suicides, and most occur between six and 12 months after giving birth.

• But establishing a connection with pregnancy can be difficult because of stigma and incomplete data, researchers said at a recent conference at the University of Arkansas for Medical Sciences.

Why it matters: These deaths not being labeled as pregnancy-related can lead to less awareness, funding and research concerning mental health-related causes of death during and following pregnancy.

Threat level: Postpartum depression affects approximately 1 in 8 people who give birth.

• Postpartum psychosis — a mental health emergency — is rarer, happening after 1 in 1,000 deliveries.
• Some mental health professionals advocate labeling suicides among those with postpartum depression as pregnancy-related, and for doing the same when new moms die of drug overdoses.

Congress passed the Preventing Maternal Deaths Act in 2018 to standardize the definitions of maternal mortality and fund state efforts to better track maternal mortality.

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"I'm proud to have been part of a team that expanded access to health insurance for so many people across Massachusetts. ... That achievement stands as a reminder of what's possible when leaders set aside partisanship and focus on serving the public good."

🥼 Biotech executive Houman Hemmati has emerged as a leading contender to be the FDA's next top vaccine and biologics regulator. (Endpoints News)

🦠 Long COVID costs developed nations up to $135 billion each year, but few have a national plan or strategy in place to address the condition. (CIDRAP)

⚕️ More than 150 companies and providers were provisionally approved to participate in a Medicare effort to expand technology-supported chronic care. (Stat)