HELP Copays Act

The "HELP Copays Act" aims to reduce patient out-of-pocket costs by requiring health insurance plans to count financial assistance towards deductibles, coinsurance, copayments, and out-of-pocket limits. This includes assistance provided by non-profit organizations and prescription drug manufacturers , ensuring these amounts directly benefit the patient's financial responsibility. The bill amends the Public Health Service Act and the Patient Protection and Affordable Care Act to standardize this practice across various health insurance coverages. A significant provision creates a safe harbor for High Deductible Health Plans (HDHPs), allowing them to count financial assistance for outpatient prescription drugs towards the minimum deductible without losing their HDHP status, effective for plan years beginning after December 31, 2025. These changes specifically apply to specialty drugs and those subject to utilization management, but explicitly state they will not impact the use of existing utilization management tools like prior authorization or step therapy. The overall goal is to ensure that third-party financial support directly contributes to a patient's satisfaction of cost-sharing requirements.