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HELP Copays Act

USA119th CongressS-864| Senate 
| Updated: 3/5/2025
Roger Marshall

Roger Marshall

Republican Senator

Kansas

Cosponsors (19)
Jeanne Shaheen (Democratic)Ruben Gallego (Democratic)Adam B. Schiff (Democratic)Thomas Tillis (Republican)Edward J. Markey (Democratic)Alex Padilla (Democratic)Christopher A. Coons (Democratic)John Boozman (Republican)Tim Kaine (Democratic)Mike Rounds (Republican)Patty Murray (Democratic)Cory A. Booker (Democratic)Jeff Merkley (Democratic)Gary C. Peters (Democratic)Richard Blumenthal (Democratic)Mark Kelly (Democratic)Ted Budd (Republican)Lisa Murkowski (Republican)Shelley Moore Capito (Republican)

Health, Education, Labor, and Pensions Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
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.
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Timeline

Bill from Previous Congress

S 118-1375
HELP Copays Act
Mar 5, 2025
Introduced in Senate
Mar 5, 2025
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Dec 4, 2025

Latest Companion Bill Action

HR 119-6423
Introduced in House
  • Bill from Previous Congress

    S 118-1375
    HELP Copays Act


  • March 5, 2025
    Introduced in Senate


  • March 5, 2025
    Read twice and referred to the Committee on Health, Education, Labor, and Pensions.


  • December 4, 2025

    Latest Companion Bill Action

    HR 119-6423
    Introduced in House

Health

Related Bills

  • HR 119-6423: HELP Copays Act

HELP Copays Act

USA119th CongressS-864| Senate 
| Updated: 3/5/2025
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.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline

Bill from Previous Congress

S 118-1375
HELP Copays Act
Mar 5, 2025
Introduced in Senate
Mar 5, 2025
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Dec 4, 2025

Latest Companion Bill Action

HR 119-6423
Introduced in House
  • Bill from Previous Congress

    S 118-1375
    HELP Copays Act


  • March 5, 2025
    Introduced in Senate


  • March 5, 2025
    Read twice and referred to the Committee on Health, Education, Labor, and Pensions.


  • December 4, 2025

    Latest Companion Bill Action

    HR 119-6423
    Introduced in House
Roger Marshall

Roger Marshall

Republican Senator

Kansas

Cosponsors (19)
Jeanne Shaheen (Democratic)Ruben Gallego (Democratic)Adam B. Schiff (Democratic)Thomas Tillis (Republican)Edward J. Markey (Democratic)Alex Padilla (Democratic)Christopher A. Coons (Democratic)John Boozman (Republican)Tim Kaine (Democratic)Mike Rounds (Republican)Patty Murray (Democratic)Cory A. Booker (Democratic)Jeff Merkley (Democratic)Gary C. Peters (Democratic)Richard Blumenthal (Democratic)Mark Kelly (Democratic)Ted Budd (Republican)Lisa Murkowski (Republican)Shelley Moore Capito (Republican)

Health, Education, Labor, and Pensions Committee

Health

Related Bills

  • HR 119-6423: HELP Copays Act
  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted