HELP Copays Act
Sponsored By: Senator Marshall, Roger [R-KS]
In Committee
Summary
Counts patient assistance toward health plan cost-sharing. This bill would require group and individual health plans to treat payments made by or for a patient, including help from nonprofit programs and prescription drug manufacturers, as amounts that count toward deductibles, copayments, coinsurance, and out-of-pocket limits.
Show full summary
- Patients and families: Financial help from nonprofit programs or drug manufacturers would lower patients' remaining cost-sharing by being credited toward deductibles and out-of-pocket caps.
- Health plans and insurers: Plans would have to include third-party payments when measuring cost-sharing for covered benefits and prescription drugs, including specialty drugs and drugs subject to utilization management.
- Drugmakers and assistance programs: Their copay and assistance payments would be counted toward patient cost-sharing and the bill creates a safe harbor so plans keep high-deductible health plan status when those payments apply to outpatient prescription drugs for plan years beginning after Dec 31, 2025.
- Care management tools: The bill keeps utilization management tools such as prior authorization and step therapy in place while applying these counting rules.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Count drug aid toward your deductible
This bill would require group and individual health plans to count payments made by drug manufacturers or nonprofit groups toward an enrollee's deductible, copayment, coinsurance, and out-of-pocket limit for prescription drugs. It would explicitly cover specialty drugs and drugs subject to prior authorization or step therapy. Plans could still use utilization management tools like prior authorization and step therapy. The rule would apply for plan years beginning on or after January 1, 2026, and plans would not lose high-deductible health plan status solely for counting this aid for plan years after December 31, 2025.
Sponsors & CoSponsors
Sponsor
Marshall, Roger [R-KS]
KS • R
Cosponsors
Sen. Kaine, Tim [D-VA]
VA • D
Sponsored 3/5/2025
Sen. Tillis, Thomas [R-NC]
NC • R
Sponsored 3/5/2025
Sen. Markey, Edward J. [D-MA]
MA • D
Sponsored 3/5/2025
Sen. Murkowski, Lisa [R-AK]
AK • R
Sponsored 3/5/2025
Sen. Merkley, Jeff [D-OR]
OR • D
Sponsored 3/5/2025
Shelley Capito
WV • R
Sponsored 3/13/2025
Sen. Coons, Christopher A. [D-DE]
DE • D
Sponsored 3/13/2025
Sen. Budd, Ted [R-NC]
NC • R
Sponsored 3/13/2025
Sen. Murray, Patty [D-WA]
WA • D
Sponsored 3/13/2025
John Boozman
AR • R
Sponsored 3/31/2025
Sen. Shaheen, Jeanne [D-NH]
NH • D
Sponsored 3/31/2025
Sen. Padilla, Alex [D-CA]
CA • D
Sponsored 11/7/2025
Sen. Gallego, Ruben [D-AZ]
AZ • D
Sponsored 12/15/2025
Gary Peters
MI • D
Sponsored 12/15/2025
Sen. Kelly, Mark [D-AZ]
AZ • D
Sponsored 12/15/2025
Sen. Blumenthal, Richard [D-CT]
CT • D
Sponsored 1/28/2026
Mike Rounds
SD • R
Sponsored 3/5/2026
Sen. Schiff, Adam B. [D-CA]
CA • D
Sponsored 3/5/2026
Sen. Booker, Cory A. [D-NJ]
NJ • D
Sponsored 3/10/2026
Sen. Whitehouse, Sheldon [D-RI]
RI • D
Sponsored 3/24/2026
Sen. Bennet, Michael F. [D-CO]
CO • D
Sponsored 3/26/2026
Sen. Heinrich, Martin [D-NM]
NM • D
Sponsored 4/13/2026
Sen. Husted, Jon [R-OH]
OH • R
Sponsored 4/30/2026
Sen. Gillibrand, Kirsten E. [D-NY]
NY • D
Sponsored 5/11/2026
Sen. Smith, Tina [D-MN]
MN • D
Sponsored 5/12/2026
Roll Call Votes
No roll call votes available for this bill.
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