Bill > HR6423

This bill, known as the HELP Copays Act (Help Ensure Lower Patient Copays Act), aims to modify how financial assistance for healthcare costs is counted towards patient 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 monetary support from these third-party sources would now be officially recognized and counted towards a patient's total healthcare spending, potentially reducing the amount patients must pay out of their own pocket. 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 explicitly states that it will not impact existing utilization management tools like prior authorization and step therapy, and it will particularly focus on specialty drugs and drugs subject to utilization management. By making these changes, the bill seeks to provide more transparency and financial relief for patients by recognizing additional sources of financial support in healthcare cost calculations.

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https://www.congress.gov/bill/119th-congress/house-bill/6423/all-info