Skip to content
Govbase
Govbase
Congress·In Committee·H.R. 6423

Rep. Kean Introduces Bipartisan HELP Copays Act to Lower Out-of-Pocket Drug Costs

HELP Copays Act

4 months ago·View on Congress.gov

Legislative Progress

House
Senate
President
Law

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.

    From policy text

    “such standards shall provide that such terms include amounts paid by, or on behalf of, an individual enrolled in a group health plan or group or individual health insurance coverage, including financial assistance offered by non-profit organizations and prescription drug manufacturers, and that such amounts shall be counted toward such deductible, coinsurance, copayment, or limit, respectively.”
    View in full text
  • 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.

    From policy text

    “The amendments made by this section shall-- (1) apply to standards relating to deductibles, coinsurance, copayments, or limits with respect to prescription drugs that are specialty drugs; (2) apply to standards relating to deductibles, coinsurance, copayments, or limits with respect to drugs that are subject to utilization management”
    View in full text
  • 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.

    From policy text

    “not impact the use of utilization management tools, including prior authorization and step therapy.”
    View in full text
  • 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.

    From policy text

    “a plan shall not fail to be treated as a high deductible health plan by reason of counting amounts paid by, or on behalf of, an individual, including financial assistance offered by non-profit organizations and prescription drug manufacturers for outpatient prescription drugs, when determining whether the minimum deductible under subparagraph (A) has been satisfied.”
    View in full text
  • 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.

    From policy text

    “This section, and the amendments made by this section, shall apply to group health plans and health insurance issuers for plan years beginning on or after January 1, 2026.”
    View in full text
Healthcare

Impact Analysis

Personal Impact

Scores: 1 = low, 5 = highSentiment: -5 to +5 (net benefit)

Milestones

2 milestones2 actions
Dec 4, 2025House

Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Dec 4, 2025

Introduced in House

Related Bills

1 bill
S. 864Identical bill

HELP Copays Act

Mar 5 — Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Source Information

Document Type

Congressional Bill

Official Title

HELP Copays Act

Bill NumberHR 6423
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sponsor

Cosponsors

(30)
D: 22R: 8

Analysis generated by AI. Always verify with official sources.