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Read. Follow. Verify.The HELP Copays Act (H.R. 6423)
Last action · December 4, 2025: 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.Sponsors: Thomas Kean and 65 others
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What This Bill Would Do
This bill requires health insurance plans to count third-party financial assistance—such as payments from non-profits or drug manufacturers—toward a patient's annual out-of-pocket costs, deductibles, and copayments. It aims to ensure that assistance provided to patients for prescription drugs helps them reach their insurance coverage limits faster.
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.
Who It Would Affect
Groups the bill's text would affect if enacted, as described in the record. Being affected is not a position for or against it.
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.
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).
Show all 8 facts
- 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?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
Currently in committee. The next step in the legislative lifecycle is Floor Vote.
Procedural history
2 actions- Dec 4, 2025HouseCommitteeReferred 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.
- Dec 4, 2025HouseIntroducedIntroduced in House
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 →Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Show 61 more sponsors
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
Sources
www.congress.gov
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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