HELP Copays Act
- Bill Number
- H.R. 6423
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-12-04: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-07-01T08:08:38Z
AI-Generated Summary
Purpose This legislation aims to ensure that financial assistance from non-profit organizations and prescription drug manufacturers counts toward an individual's cost-sharing obligations in health insurance plans, potentially reducing out-of-pocket expenses for certain medications.
Key Provisions
- Amends Section 2715(g)(1) of the Public Health Service Act to require that standards for defining deductible, coinsurance, copayment, and out-of-pocket limit include amounts paid by or on behalf of the enrollee.
- Makes conforming changes to the Patient Protection and Affordable Care Act (Section 1302(c)(3)), the Public Health Service Act (Section 2707(b)), and the Internal Revenue Code (Section 223(c)(2)) to align definitions and create a safe harbor for high-deductible health plans.
- Applies specifically to prescription drugs, including specialty drugs and those subject to utilization management.
- Clarifies that the changes do not restrict the use of prior authorization or step therapy.
- Sets an effective date for plan years beginning on or after January 1, 2026.
Significant Changes to Existing Law
- Expands the definition of cost-sharing amounts to explicitly include third-party financial assistance, which was not previously required to count toward deductibles or out-of-pocket limits in the referenced statutes.
- Introduces a safe harbor in tax law allowing high-deductible health plans to count such assistance without losing their status.
- Applies the changes to the prescription drug category of essential health benefits.
Potential Impacts
- On citizens: May lower effective out-of-pocket costs for patients using manufacturer or non-profit assistance programs for covered drugs.
- On government agencies: Requires updates to regulatory standards by the Department of Health and Human Services and potential adjustments in tax administration by the Internal Revenue Service.
- On health insurance issuers and plans: Mandates inclusion of assistance amounts in cost-sharing calculations, which could affect plan design and premium calculations.
- No direct effects on international relations are specified.
Main Stakeholders Affected
- Health insurance issuers and group health plans.
- Patients enrolled in such plans who receive financial assistance for prescription drugs.
- Prescription drug manufacturers and non-profit organizations providing assistance.
- Federal agencies including the Department of Health and Human Services and the Internal Revenue Service.
- Employers sponsoring health plans.
Notable Legal, Constitutional, or Political Implications
- The bill relies on amendments to existing federal health statutes without altering core constitutional authorities over interstate commerce or taxation.
- It preserves existing utilization management practices, limiting potential conflicts with plan flexibility.
- The changes are limited to domestic health coverage rules and do not address state-level insurance regulations directly.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (58)
Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Miller-Meeks, Mariannette [R-IA-1], Rep. Auchincloss, Jake [D-MA-4], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Watson Coleman, Bonnie [D-NJ-12], Rep. Matsui, Doris O. [D-CA-7], Rep. Simon, Lateefah [D-CA-12], Rep. Ross, Deborah K. [D-NC-2], Rep. Davids, Sharice [D-KS-3], Rep. Ciscomani, Juan [R-AZ-6], Rep. Bonamici, Suzanne [D-OR-1], Rep. Levin, Mike [D-CA-49], Rep. Pfluger, August [R-TX-11], Rep. Quigley, Mike [D-IL-5], Rep. Lieu, Ted [D-CA-36], Rep. Panetta, Jimmy [D-CA-19], Rep. Gottheimer, Josh [D-NJ-5], Rep. Wilson, Joe [R-SC-2], Rep. Salazar, Maria Elvira [R-FL-27], Rep. Stevens, Haley M. [D-MI-11], Rep. Case, Ed [D-HI-1], Rep. Subramanyam, Suhas [D-VA-10], Rep. Meuser, Daniel [R-PA-9], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Goldman, Daniel S. [D-NY-10], Rep. Pocan, Mark [D-WI-2], Rep. LaLota, Nick [R-NY-1], Rep. Cohen, Steve [D-TN-9], Rep. Tokuda, Jill N. [D-HI-2], Rep. Pappas, Chris [D-NH-1], Rep. Moulton, Seth [D-MA-6], Rep. Balint, Becca [D-VT-At Large], Rep. Adams, Alma S. [D-NC-12], Rep. DelBene, Suzan K. [D-WA-1], Rep. Houlahan, Chrissy [D-PA-6], Rep. Bynum, Janelle S. [D-OR-5], Rep. Lee, Summer L. [D-PA-12], Rep. Kiggans, Jennifer A. [R-VA-2], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Riley, Josh [D-NY-19], Rep. Crow, Jason [D-CO-6], Rep. Kennedy, Timothy M. [D-NY-26], Rep. Torres, Ritchie [D-NY-15], Rep. Conaway, Herbert C. [D-NJ-3], Rep. Hayes, Jahana [D-CT-5], Rep. Foster, Bill [D-IL-11], Rep. Barrett, Tom [R-MI-7], Rep. Rutherford, John H. [R-FL-5], Rep. Lynch, Stephen F. [D-MA-8], Rep. Pingree, Chellie [D-ME-1] and 8 more
Recent Actions
- 2025-12-04: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-12-04: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2025-12-04: Introduced in House
- 2025-12-04: Introduced in House
Bill Versions
- Help Ensure Lower Patient Copays Act — issued 2025-12-04 — PDF (5 pages)