S. 864 — HELP Copays Act

This section requires that amounts paid by, or on behalf of, an enrollee—including financial assistance from non-profit organizations and prescription drug manufacturers—count toward a health plan's deductibles, coinsurance, copayments, and out-of-pocket limits under the Public Health Service Act (PHSA), for plan years beginning on or after January 1, 2026. It makes conforming amendments to (1) the Patient Protection and Affordable Care Act's essential health benefits cost-sharing requirements (42 U.S.C. 18022(c)(3)); (2) PHSA comprehensive primary care cost-sharing limits as applied to prescription drugs; and (3) the Internal Revenue Code's high-deductible health plan rules (26 U.S.C. 223(c)(2)), providing a safe harbor so such assistance for outpatient prescription drugs does not disqualify a plan. (Thus, enrollees receiving such assistance will more quickly satisfy cost-sharing requirements, including for specialty drugs and those subject to utilization management, without affecting prior authorization or step therapy.)