The HELP Copays Act would allow financial assistance from nonprofits and drug manufacturers to count toward patients' deductibles, copayments, coinsurance, and out-of-pocket limits in health insurance plans. Currently, such assistance is often excluded from these cost-sharing calculations, meaning patients must still pay their full out-of-pocket costs even when receiving help from outside organizations. The bill would apply to both group health plans and individual insurance coverage, and it includes a special safe harbor for high-deductible health plans starting in 2026 to ensure they maintain compliance with tax laws. The changes take effect on January 1, 2026, and do not restrict insurers' ability to use utilization management tools like prior authorization or step therapy for prescription drugs. This bipartisan legislation aims to reduce the actual costs patients pay out-of-pocket by crediting them for financial assistance they receive from manufacturers and charitable organizations.
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