HELP Copays Act

This bill would require health insurance plans to count payments made by or on behalf of an enrolled person, including financial help from nonprofit groups and prescription drug makers, toward the person's deductible, coinsurance, copayment, and yearly out-of-pocket limit. It applies to both group health plans and individual health insurance coverage. It states that high deductible health plans tied to health savings accounts would keep that status if they count this help for outpatient prescription drugs toward the minimum deductible. The rules would cover specialty drugs and drugs subject to utilization management, but would not change insurers' use of tools such as prior authorization and step therapy. The changes would apply to plan years starting on or after January 1, 2026.

Full text and official record on Congress.gov

Sponsors

• Roger Marshall Republican sponsor
• 28 cosponsors