GoodRx's CEO Wants DPC's HSA Win Extended. The Narrowness Is Why DPC Won.

Legislation by DPC Insider — Policy Desk
#HSA#GoodRx#legislation#One Big Beautiful Bill#IRS#tax policy
Sources: Let Americans Keep the Savings They Find (Wendy Barnes, RealClearPolitics) · Notice 2026-5: Expansion of Health Savings Account Availability and Eligibility Under the OBBBA · H.R. 8270 (IH) — Every Dollar Counts Act of 2026 · Murphy Introduces Legislation to Lower Out-of-Pocket Costs for Drugs · Tax Treatment — Direct Primary Care Frontier · 26 U.S.C. § 223 — Health savings accounts (as amended by Pub. L. 119-21, § 71308) · Treasury, IRS provide guidance on new tax benefits for HSA participants under the One Big Beautiful Bill (Notice 2026-5) · H.R. 8270 (IH) full text — Every Dollar Counts Act of 2026 · GoodRx Holdings, Inc. 2026 proxy statement (DEF 14A), filed April 29, 2026 · STATE OF DIRECT PRIMARY CARE — DPCA Member Insights Committee, 2026

This week the chief executive of a publicly traded prescription-pricing company published an op-ed arguing that Congress should let Americans pay for health care memberships with pre-tax dollars. The evidence offered that this can be done: direct primary care.

Wendy Barnes, president and CEO of GoodRx, made the case in RealClearPolitics. “Congress has already begun to recognize that health care memberships can be legitimate medical expenses,” the piece reads. “As of this year, certain direct primary care memberships can be paid tax-free from an HSA under a change implemented through IRS guidance.”

Then comes the ask. “But that change is narrowly limited, leaving out broader memberships that may combine prescription savings, virtual care, and other services. Lawmakers should extend the same principle to other health care memberships and to HSAs and FSAs.”

DPC won something in January. Eight months later, it is being used as the opening argument for someone else’s expansion.

Two proposals, one of which is already a bill

The op-ed makes two requests, and they are at very different stages.

The first is the Every Dollar Counts Act, H.R. 8270, introduced on April 14, 2026 by Rep. Greg Murphy of North Carolina. It targets one situation: a patient whose plan covers a drug decides to buy it without running it through the plan. Under many plans, that cash payment earns no credit against the deductible. The bill would make the plan credit it anyway, toward the deductible and the out-of-pocket maximum both. The requirement runs through the Public Health Service Act, ERISA, and the tax code, so it reaches group health plans and insurers selling group or individual coverage. It carries no Medicare provisions, though it does amend the Medicaid drug rebate statute so those cash prices stay out of best-price and average-manufacturer-price math. It would apply to plan years starting January 1, 2027, and it currently sits with a handful of cosponsors and no floor action.

The op-ed names no bill behind the second request. It is a principle: extend membership eligibility to HSAs and FSAs generally, with “clear eligibility standards and reasonable monthly limits” to prevent abuse. That one is worth reading twice if you run a DPC practice.

The carve-out is a statute, not guidance

One correction, because it changes who is able to undo this.

DPC memberships did not become HSA-compatible through IRS guidance. Section 71308 of the One Big Beautiful Bill Act, Public Law 119-21, amended Internal Revenue Code section 223(c)(1) directly. The change applies to months beginning after December 31, 2025. IRS Notice 2026-5, released December 9, 2025, implements the statute rather than creating it.

That distinction matters. A statutory carve-out takes an act of Congress to change. Guidance takes a notice. Anyone arguing that the DPC provision should be widened is asking for legislation, not a memo, and the same is true of anyone who might later want it narrowed.

Narrow was the entire argument

Here is what “narrowly limited” actually looks like in the statute.

A qualifying arrangement pays for primary care services from a primary care practitioner, in exchange for a fixed periodic fee. The fee cannot exceed $150 per month for one individual or $300 per month for an arrangement covering more than one, with inflation adjustments after 2026. That ceiling sits above what practices reported charging the last time anyone counted. The DPC Alliance’s State of Direct Primary Care report, published in 2026 on survey responses collected in October 2024, puts every reported monthly membership figure between roughly $78 and $114, whether the practice is urban or rural, new or mature, small-panel or large. That data predates the cap taking effect, and pricing still varies by practice and location.

Then there is the exclusion list. A qualifying arrangement cannot include procedures requiring general anesthesia, prescription drugs other than vaccines, or laboratory services not typically provided in an ambulatory primary care setting.

Read that list against the op-ed’s description of the memberships it wants covered: ones “that may combine prescription savings, virtual care, and other services.” Prescription drugs beyond vaccines are the specific thing section 223(c)(1) rules out. That line is in the statute, and a prescription-savings membership sits on the far side of it.

The line exists because of what DPC was fighting before 2026. A direct primary care arrangement counted as a health plan under section 223(c)(1)(A)(ii), and the IRS now frames the fix as letting an otherwise eligible patient enrolled in certain DPC arrangements contribute to an HSA. The whole argument was that a direct primary care arrangement is a service contract with a doctor, not coverage. The exclusion list is what makes that argument checkable by an auditor. Strip out anesthesia, drugs, and hospital-grade labs and what remains genuinely cannot function as insurance.

The narrowness was the win.

The Counterargument

The strongest version of the GoodRx case is not hard to make, and DPC physicians should weigh it before dismissing it.

A patient who pays $10 a month for a membership that drops a generic from $80 to $30 is doing precisely what HSA policy claims to reward: spending their own money, shopping on price, lowering total cost. Telling that patient the $30 prescription qualifies but the membership that produced the $30 price does not is a strange rule to defend. And DPC benefits when “health care membership” becomes a familiar, well-understood category in tax law instead of an exotic one that every benefits administrator has to look up.

That case is real. The claim still holds, for one structural reason.

For a DPC practice, the real value of section 223(c)(1)(E) is the definitional fence rather than the tax deduction. A statute that says what a direct primary care service arrangement is, with an exclusion list attached, is what keeps the arrangement from being reclassified as coverage the next time an agency looks at it. Broaden the category to include memberships built on prescription discounts and bundled virtual visits without keeping an equally tight fence around each type, and the first question a future regulator asks is whether the whole class is a health plan.

There is a second question DPC advocates should be asking, and it is a question rather than a prediction, because nobody has drafted the text yet. The $150 cap is a fixed number attached to a specific arrangement. If Congress converts it into a general monthly allowance for health care memberships of all kinds, does a DPC membership start competing for that room against a prescription-discount subscription and a telehealth plan? On the current statute, no. On a broadened one, it depends entirely on the drafting.

Nobody at GoodRx is trying to hurt direct primary care. But DPC is being cited here as a precedent, and precedents get stretched by whoever picks them up next. The version of this expansion that helps DPC keeps the definition intact and adds new categories alongside it. The version that hurts DPC replaces a specific definition with a general one, and calls that a simplification.