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.