HELP Copays Act

Key Points

• This bill requires health insurance companies to count any financial help a patient receives toward their yearly deductible and out-of-pocket maximum. This includes coupons from drug makers or grants from non-profit charities.
• The policy is designed to help people with chronic or rare diseases who rely on expensive 'specialty' drugs. Currently, many insurance plans take the coupon money but don't credit it to the patient's deductible, leaving the patient with a surprise bill later in the year.
• If passed, these rules would apply to most private health insurance plans and high-deductible plans starting on January 1, 2026. It ensures that if money is paid for a drug on a patient's behalf, it counts as if the patient paid it themselves.
• The bill specifically covers specialty drugs and medications that require special permission from an insurer. However, it does not stop insurance companies from using other tools like 'step therapy,' where a patient must try a cheaper drug before a more expensive one is covered.

Votes

No votes have been recorded for this legislation yet.