HELP Copays Act Mandates Insurers Count Drug Assistance Toward Deductibles Starting 2026

The Help Ensure Lower Patient Copays Act, or the HELP Copays Act, is taking aim at a frustrating loophole that hits people with chronic conditions the hardest. Essentially, this bill forces health insurance companies and group health plans to count financial assistance received from outside groups—like non-profits or drug manufacturers—toward your annual out-of-pocket maximums, deductibles, and copayments.

The Cost-Sharing Loophole, Closed

If you or a family member relies on an expensive specialty drug, you know the drill: the manufacturer or a charity offers a coupon or financial aid to cover your massive copay. But under many current insurance plans, that money is treated like a gift, not a payment, meaning it doesn't count toward the thousands of dollars you need to spend before your insurance truly kicks in. You hit your maximum with your own cash, not the assistance money. The HELP Copays Act changes this, requiring that third-party assistance must be credited toward your cost-sharing requirements. This is a huge win for patients who need high-cost medications, as it means they will reach their annual out-of-pocket spending limits much faster, potentially saving them thousands of dollars in personal funds (Sec. 2).

High Deductibles Get a Pass

The bill also addresses a specific concern for those enrolled in High Deductible Health Plans (HDHPs) linked to Health Savings Accounts (HSAs). Currently, if a plan lets you use assistance money before you hit your minimum deductible, it can lose its special tax status. Starting after December 31, 2025, this bill ensures that HDHPs can count third-party assistance for outpatient prescription drugs toward that deductible without losing their favorable tax status. This provides necessary flexibility, making sure that people with HDHPs who need immediate access to expensive meds don't have to choose between their tax-advantaged savings account and getting their medication (Sec. 2).

The Real-World Trade-Offs

While this sounds like a straight win for patients—and in terms of immediate access, it is—there’s a complex economic undercurrent here. This change essentially guarantees that drug manufacturer assistance will count toward a patient’s limit, which removes a major incentive for manufacturers to lower their list prices. Think of it this way: if a drug costs $10,000, and the manufacturer offers a $5,000 coupon that now must count toward your deductible, the manufacturer has successfully ensured the patient gets the drug without the patient having to fight the high price tag. Insurers, who previously used 'copay accumulator' policies to push back against these high list prices, now lose that leverage. This could potentially lead to higher overall system costs or, eventually, higher premiums for everyone, as insurers adjust to this new requirement.

What Isn't Changing

It’s important to note what the bill doesn't do. It explicitly states that it does not change how insurance companies manage utilization. This means that if your insurer requires prior authorization or step therapy (making you try a cheaper drug first) before covering an expensive drug, those rules are staying put. The HELP Copays Act is focused solely on how the dollars are counted, not on how the access controls are applied. These new rules are scheduled to kick in for plan years beginning on or after January 1, 2026.