HELP Copays Act

Summary#

This bill changes federal insurance rules so that money paid by, or on behalf of, an insured person counts toward that person’s deductible, coinsurance, copayment, or out-of-pocket limit. The counted payments include financial help from nonprofit organizations and prescription drug manufacturers. The bill adds matching language to parts of the Affordable Care Act and the Public Health Service Act, and it creates an IRS safe harbor so counting such assistance for outpatient prescription drugs won’t make a plan lose high-deductible health plan status. The rules apply to specialty drugs and drugs subject to utilization management. The bill says it does not affect use of utilization management tools like prior authorization or step therapy. The changes apply to plan years starting on or after January 1, 2026.

What it means for you#

• If you have group or individual health coverage, third-party help that pays toward your copay or deductible must be counted as meeting that cost-sharing amount.
• This includes assistance from nonprofit groups and drug manufacturers.
• It applies to regular and specialty prescription drugs, even when those drugs have utilization controls.
• For plans labeled high-deductible, counting this help for outpatient prescriptions will not automatically break the plan’s high-deductible status under the new IRS language.
• The rules take effect for plan years beginning January 1, 2026.

Expenses#

No publicly available information on the bill’s budgetary costs, savings, or fiscal impact is included in the bill text or metadata.

Proponents' View#

The bill’s title and text show supporters aim to ensure third-party patient assistance reduces a person’s counted out-of-pocket costs by requiring such payments to be applied to deductibles and copays. The bill was introduced by a bipartisan group of senators listed in the metadata.

Opponents' View#

No publicly available information on opposition, objections, or counterarguments is included in the bill text or metadata.