HELP Copays Act

Key Points

• This bill requires health insurers to count financial assistance—like drug manufacturer coupons and nonprofit grants—toward a patient's deductible, copayment, coinsurance, and out-of-pocket limit. Right now, many insurers accept these payments but don't credit them toward a patient's spending cap.
• The bill specifically applies to expensive specialty drugs and drugs subject to utilization management (like prior authorization), which are often the treatments that come with the highest out-of-pocket costs for patients with chronic or rare conditions.
• Insurance companies can still use cost-control tools like step therapy (trying cheaper drugs first) and prior authorization. The bill only changes how payments are counted, not whether a drug is approved for coverage.
• The bill includes a safe harbor for high-deductible health plans paired with Health Savings Accounts, ensuring that counting manufacturer assistance toward the deductible won't disqualify the plan from HSA eligibility.
• If enacted, the new rules would take effect for plan years beginning on or after January 1, 2026, applying to both group health plans and individual health insurance coverage.

Votes

No votes have been recorded for this legislation yet.