H.R. 6423 — HELP Copays Act

This section requires that amounts paid by, or on behalf of, an individual—including financial assistance from non-profit organizations and prescription drug manufacturers—count toward deductibles, coinsurance, copayments, and out-of-pocket limits in group health plans and health insurance coverage. It makes conforming amendments to (1) Public Health Service Act (PHSA) standards for defining cost-sharing terms; (2) Patient Protection and Affordable Care Act (ACA) cost-sharing requirements for essential health benefits; (3) PHSA comprehensive primary care cost-sharing limits, applied to prescription drugs within the essential health benefits category; and (4) Internal Revenue Code high-deductible health plan rules, providing a safe harbor for counting such assistance toward the minimum deductible for outpatient prescription drugs in plan years beginning after December 31, 2025. The amendments apply to specialty drugs and drugs subject to utilization management but do not affect prior authorization or step therapy, and take effect for plan years beginning on or after January 1, 2026. (Thus, patient assistance programs will reduce enrollees' effective cost-sharing under ACA-compliant plans and health savings account-eligible plans.)