The HELP Copays Act (H.R. 6423)
December 4, 2025
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Where This Stands
Currently in_committee. The next step in the legislative lifecycle is Floor Vote.
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →The Frame
Starting January 1, 2026, patients using financial assistance for prescription drugs will have those payments count toward their insurance deductibles and out-of-pocket maximums, potentially lowering the amount they must pay out of their own pockets to reach their coverage limits.
Potentially affected actors named in the source documents. Mention is not a position.
Patients using prescription drug financial assistance
Financial assistance provided by third parties will now count toward their insurance cost-sharing requirements.
Health insurance issuers
Must adjust their accounting of deductibles and out-of-pocket limits to include third-party financial assistance.
Prescription drug manufacturers
Their financial assistance programs will now be recognized by insurance plans for the purpose of meeting patient cost-sharing requirements.
Current stage: in_committee.
Floor Vote.
Summary
Why It Matters
Starting January 1, 2026, patients using financial assistance for prescription drugs will have those payments count toward their insurance deductibles and out-of-pocket maximums, potentially lowering the amount they must pay out of their own pockets to reach their coverage limits.
Key Facts
- Requires health insurance plans to count financial assistance from non-profits and drug manufacturers toward a patient's deductible, coinsurance, copayment, and out-of-pocket limits.
- Applies to group health plans and individual health insurance coverage.
- Specifically targets prescription drugs, including specialty drugs and drugs subject to utilization management.
- Amends the Public Health Service Act and the Patient Protection and Affordable Care Act (PPACA).
- Amends the Internal Revenue Code to ensure high-deductible health plans (HDHPs) maintain their tax-advantaged status even when third-party assistance is counted toward deductibles.
- Effective for plan years beginning on or after January 1, 2026.
- Does not prohibit or change the use of utilization management tools like prior authorization or step therapy.
- Applies to plan years beginning after December 31, 2025, for the Internal Revenue Code safe harbor provision.
Frequently Asked Questions
Will this bill stop insurance companies from using 'step therapy' or 'prior authorization'?
When does this change take effect?
Does this apply to all prescription drugs?
News Coverage
Sponsors
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Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Standardization of Third-Party Assistance
The bill represents a federal effort to standardize how insurance plans treat third-party financial assistance, effectively overriding current insurance practices that exclude such payments from cost-sharing totals.
Connected Entities
Analysis Score
0–100- Significance75How much this matters to a regular citizen
- Controversy30Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz25Current news / social attention level
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