HELP Copays Act

The HELP Copays Act would change how health insurance plans treat financial assistance for prescription drugs. Currently, when patients receive copay assistance from nonprofit organizations or drug manufacturers, many insurers do not count those payments toward the patient's annual deductible or out-of-pocket maximum. This means patients can exhaust their assistance and still owe thousands in out-of-pocket costs, even though they should have reached their yearly limit. The bill would require insurers and pharmacy benefit managers to count all copay assistance toward these cost-sharing requirements, ensuring that financial help actually reduces what patients must pay.

The legislation would apply to prescription drugs covered by health plans, treating them as essential health benefits. This would prevent insurers from using what are called copay accumulator or maximizer programs, which currently allow them to pocket assistance payments without crediting them to patient costs. The bill has bipartisan support in the Senate and is currently under consideration by the Committee on Health, Education, Labor, and Pensions. If enacted, it could make prescription medications more affordable for patients with chronic and serious conditions by ensuring that all assistance counts toward their cost-sharing obligations.