HELP Copays Act

This bill amends the Public Health Service Act to mandate that financial assistance provided to patients counts towards their health insurance plan's cost-sharing requirements. It specifically requires that amounts paid by or on behalf of an individual, including aid from non-profit organizations and prescription drug manufacturers , must be applied to deductibles, coinsurance, copayments, and out-of-pocket limits. This ensures that third-party payments directly reduce a patient's financial burden for covered health services, including specialty drugs and those subject to utilization management. The legislation includes conforming amendments to the Patient Protection and Affordable Care Act, clarifying that the limitation on out-of-pocket expenses applies to prescription drugs as essential health benefits. It also establishes a safe harbor for high-deductible health plans, allowing them to count financial assistance for outpatient prescription drugs towards the deductible without losing their status. These provisions are set to take effect for group health plans and health insurance issuers for plan years beginning on or after January 1, 2026 , without impacting the use of utilization management tools.