News Summary
The HELP Copays Act is a bipartisan legislative effort in Congress aimed at prohibiting copay accumulator and maximizer practices that hinder patient access to medications. By ensuring all financial assistance counts toward deductibles and out-of-pocket maximums, this crucial bill seeks to alleviate the financial burden on patients, particularly those with chronic conditions. The act is currently under consideration in both the House and the Senate, with significant backing from advocacy groups and lawmakers.
Washington, D.C.
A significant bipartisan legislative effort to ease the financial burden on patients facing high prescription drug costs is gaining renewed attention in the U.S. Congress. The Help Ensure Lower Patient Copays (HELP Copays) Act, legislation designed to prohibit health insurance companies from using “copay accumulator” and “copay maximizer” programs, is currently under consideration in the House of Representatives and has a companion bill in the Senate. This crucial bill aims to ensure that all financial assistance patients receive, such as manufacturer coupons and charitable aid, directly contributes to their annual deductibles and out-of-pocket maximums Nationwide.
The core purpose of the HELP Copays Act is to protect patients from hidden costs associated with certain health insurance practices. These practices often leave individuals, particularly those with chronic conditions, unexpectedly responsible for substantial out-of-pocket expenses for their vital, often life-saving medications. If passed, this federal solution would provide consistent protection for patients across the country, preventing programs that currently prevent patient assistance from counting toward their healthcare costs.
Protecting Patients from Hidden Costs
The primary target of the HELP Copays Act is a practice known as copay accumulator adjustment programs. These programs prevent third-party payments and other forms of financial assistance from counting toward a patient’s deductible or annual out-of-pocket limits. As a result, when a patient’s assistance runs out, they are unexpectedly faced with significant expenses, even if they believed they were closer to meeting their yearly maximum. This practice disproportionately affects individuals with chronic conditions who rely on costly, life-saving medications and often depend on such assistance to afford their treatments.
The legislation, specifically H.R.830 in the House and S.864 in the Senate, explicitly requires health insurance plans to apply all forms of patient support—including financial assistance, discounts, and product vouchers—toward a plan’s cost-sharing requirements. Beyond copay accumulators, the bill also seeks to clarify that the Affordable Care Act’s (ACA) annual out-of-pocket limit applies to all prescription drugs covered by a health plan. This clarification ensures that these drugs are defined as “essential health benefits,” thereby prohibiting the use of “copay maximizer” schemes that circumvent ACA regulations.
Bipartisan Momentum and Broad Support
The HELP Copays Act was first introduced in the House as H.R.830 on February 6, 2023. Its companion bill, S.1375, was initially introduced in the Senate on April 27, 2023, and later reintroduced as S.864 on March 7, 2025. This reintroduction ensures the bill’s continued presence and consideration in the 119th Congress (2025-2026), highlighting an ongoing legislative push to address these issues. The dual-chamber effort and the reintroduction underscore a shared understanding among lawmakers of the urgent need to address patient affordability challenges Nationwide, and the bill has garnered significant bipartisan backing in both chambers of Congress.
A broad coalition of patient advocacy groups has voiced strong support for the HELP Copays Act. Organizations such as the Arthritis Foundation, the Allergy & Asthma Network, and the Immune Deficiency Foundation (IDF) have emphasized that copay accumulator programs often deplete patient assistance without providing any credit toward their cost-sharing obligations. This practice leaves individuals in financially precarious situations. The “All Copays Count Coalition,” which includes 75 national patient and provider organizations, has formally praised the introduction of this bipartisan measure, advocating for a federal solution to this widespread problem impacting patients Nationwide.
Broader Context: Addressing Prescription Drug Affordability
The renewed push for the HELP Copays Act takes place amidst ongoing discussions and broader legislative efforts aimed at making prescription medications more affordable across the United States. While some progress has been made at the local level, a federal solution is sought to ensure consistent protection. To date, twenty-four states, the District of Columbia, and Puerto Rico have banned copay accumulators at the State-level. However, these bans do not universally address copay maximizers, pointing to the need for a comprehensive federal approach.
Adding further momentum to the cause, a U.S. District Court ruling on September 29, 2023, temporarily reinstated a ban on copay accumulators for certain medications without generic alternatives. This ruling applied to both federally and state-regulated insurance plans. Although the Department of Health and Human Services (HHS) initially appealed this decision, significant backlash from patient organizations and members of Congress ultimately led HHS to drop its appeal. This legal development further underscores the widespread recognition of the harm caused by these programs and reinforces the need for a comprehensive legislative fix that would apply Nationwide.
The legislative landscape also includes broader discussions around Pharmacy Benefit Manager (PBM) reform. Both Senate and House committees are examining PBM practices to ensure greater transparency and reduce drug costs for consumers Nationwide. The HELP Copays Act represents a targeted effort within this larger initiative, aiming to directly impact patients’ out-of-pocket expenses for essential medications. As the bill progresses through the House and Senate, patient advocates continue to urge lawmakers to prioritize its passage, emphasizing its potential to provide crucial financial relief and ensure equitable access to necessary treatments for millions of Americans Nationwide.
Frequently Asked Questions (FAQ) about the HELP Copays Act
- What is the purpose of the HELP Copays Act?
- The HELP Copays Act is a Nationwide bipartisan legislative effort aimed at prohibiting “copay accumulator” and “copay maximizer” schemes used by health plans and Pharmacy Benefit Managers (PBMs). It requires health insurance plans to count all forms of patient financial assistance, such as manufacturer coupons and charitable aid, towards a patient’s annual deductibles and out-of-pocket maximums.
- How do “copay accumulator” programs harm patients?
- “Copay accumulator” programs prevent third-party payments and financial assistance from counting toward a patient’s deductible or annual out-of-pocket limits. This means that when a patient’s assistance runs out, they can unexpectedly face substantial out-of-pocket expenses, even if they believed they were closer to meeting their yearly maximum. This primarily affects individuals with chronic conditions who rely on costly medications Nationwide.
- What are “copay maximizer” programs?
- “Copay maximizer” programs declare certain medications as “nonessential health benefits” to circumvent Affordable Care Act (ACA) regulations. They then set a patient’s cost-sharing for these drugs based on the maximum copay assistance available from the manufacturer. Once this assistance is exhausted, the insurer then drops the patient’s out-of-pocket cost to zero, effectively draining the assistance without applying it to the patient’s cost-sharing obligations.
- Is the HELP Copays Act a federal or state initiative?
- The HELP Copays Act is a federal initiative, introduced as H.R.830 in the House and S.864 in the Senate. If passed, it would apply Nationwide.
- When was the HELP Copays Act introduced?
- H.R.830, the House version of the HELP Copays Act, was introduced on February 6, 2023. A companion bill, S.864, was reintroduced in the Senate on March 7, 2025.
- Does the HELP Copays Act have bipartisan support?
- Yes, the HELP Copays Act has significant bipartisan support in both the House and Senate.
- Have any states addressed copay accumulators?
- Yes, twenty-four states, plus the District of Columbia, and Puerto Rico have banned copay accumulators at the State-level. However, these bans do not universally address copay maximizers.
Key Features of the HELP Copays Act
| Feature | Description | Scope |
|---|---|---|
| Prohibits Copay Accumulators | Bans health insurance plans from using programs that prevent patient financial assistance from counting towards deductibles and out-of-pocket limits. | Nationwide |
| Eliminates Copay Maximizers | Addresses schemes where health plans classify certain drugs as “non-essential health benefits” to drain copay assistance without crediting patient cost-sharing. | Nationwide |
| Counts All Financial Assistance | Requires health plans to apply all forms of patient financial aid, including manufacturer coupons and charitable assistance, towards a patient’s annual deductible and out-of-pocket maximum. | Nationwide |
| Clarifies ACA Out-of-Pocket Limits | Ensures the Affordable Care Act’s annual out-of-pocket limits apply to all covered prescription drugs. | Nationwide |
| Bipartisan Support | Enjoys significant backing from both Republican and Democratic lawmakers in both the House and Senate. | Nationwide |
| Addresses Patient Financial Burden | Aims to reduce unexpected high out-of-pocket costs for patients, especially those with chronic conditions. | Nationwide |
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Author: STAFF HERE NOVI WRITER
The NOVI STAFF WRITER represents the experienced team at HERENovi.com, your go-to source for actionable local news and information in Novi, Oakland County, and beyond. Specializing in "news you can use," we cover essential topics like product reviews for personal and business needs, local business directories, politics, real estate trends, neighborhood insights, and state news affecting the area—with deep expertise drawn from years of dedicated reporting and strong community input, including local press releases and business updates. We deliver top reporting on high-value events such as Motor City Comic Con, Michigan State Fair, and Novi Home and Garden Show. Our coverage extends to key organizations like the Novi Chamber of Commerce and Novi Community Foundation, plus leading businesses in automotive, technology, and manufacturing that power the local economy such as Gentherm, Stoneridge, and Daifuku North America. As part of the broader HERE network, including HEREDetroitMI.com, HEREGrandRapids.com, HERENorthville.com, and HEREPlymouth.com, we provide comprehensive, credible insights into Michigan's dynamic landscape.
