HELP Copays Act

The HELP Copays Act requires that financial assistance from non-profit organizations or prescription drug manufacturers counts toward patients' annual out-of-pocket cost-sharing limits (like deductibles and copays) for certain prescription drugs. It directly affects individuals enrolled in group health plans or individual insurance who receive such assistance, ensuring payments from these sources reduce their total out-of-pocket spending. The bill amends key healthcare laws to include these payments in calculating cost-sharing thresholds, specifically for specialty drugs and drugs subject to utilization management (like prior authorization). It takes effect for plan years beginning in 2026 and does not change how utilization management tools are applied.