Bill > S864

This bill, known as the HELP Copays Act (Help Ensure Lower Patient Copays Act), aims to change how financial assistance for healthcare is counted towards patients' out-of-pocket expenses. Specifically, the bill requires that financial assistance from non-profit organizations and prescription drug manufacturers be included when calculating a patient's deductible, coinsurance, copayment, and out-of-pocket limits for health insurance plans. This means that if a patient receives financial aid from a charity or a drug manufacturer to help pay for prescription drugs, those contributions will now be counted towards their total healthcare expenses, potentially helping patients reach their out-of-pocket maximums more quickly and reducing their overall healthcare costs. The bill applies to both group and individual health insurance plans and will take effect for plan years beginning on or after January 1, 2026. Importantly, the legislation does not change the use of utilization management tools like prior authorization and step therapy, and it specifically focuses on specialty drugs and drugs subject to utilization management. The bill amends several existing laws, including the Public Health Service Act and the Patient Protection and Affordable Care Act, to implement these changes.

Health and Social Services

https://www.congress.gov/bill/119th-congress/senate-bill/864/all-info