HELP Copays Act
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Overview
The Help Ensure Lower Patient Copays Act amends existing healthcare laws to broaden the definition of what counts toward a patient’s deductible, coinsurance, or copayment. Specifically, it includes financial assistance provided by non-profit organizations and prescription drug manufacturers when calculating these costs. The bill also makes changes to how the Affordable Care Act and the Public Health Service Act define these terms, and establishes a safe harbor for plans that include such assistance in their calculations.
Key provisions
- Expands the definition of cost-sharing to include financial assistance from non-profit organizations and prescription drug manufacturers.
- Modifies the Patient Protection and Affordable Care Act to incorporate this expanded definition.
- Updates the Public Health Service Act to align with the changes in the Affordable Care Act.
- Creates a safe harbor for plans that include prescription drug assistance in their deductible calculations starting in 2026.
- Applies the changes to specialty drugs and drugs subject to utilization management.
Who is affected
- Individuals enrolled in health insurance plans (group and individual)
- Health insurance issuers
- Non-profit organizations
- Prescription drug manufacturers
- Healthcare providers
Notable changes
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