S. 864 · In committee · Health

HELP Copays Act

What it does

Amends the Public Health Service Act to require that financial assistance from non-profit organizations and prescription drug manufacturers count toward deductibles, coinsurance, copayments, and out-of-pocket limits in group health plans and individual insurance coverage.
Applies the same counting rule to Patient Protection and Affordable Care Act metal-level plans, requiring third-party financial assistance to be credited toward cost-sharing thresholds.
Creates a safe harbor under Internal Revenue Code Section 223 allowing high-deductible health plans to count non-profit and manufacturer assistance for outpatient prescription drugs toward minimum deductibles without losing tax-favored status, effective for plan years beginning after December 31, 2025.
Preserves the ability of plans to use utilization management tools including prior authorization and step therapy, and applies the rule to both specialty drugs and drugs subject to utilization management.

Mar 19, 2026: Committee on Health, Education, Labor, and Pensions. Hearings held.

Committee: Senate Health, Education, Labor, and Pensions