HELP Copays Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 864 Introduced in Senate (IS)]

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119th CONGRESS
  1st Session
                                 S. 864

    To amend title XXVII of the Public Health Service Act to apply 
 financial assistance towards the cost-sharing requirements of health 
                insurance plans, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 5, 2025

   Mr. Marshall (for himself, Mr. Kaine, Mr. Tillis, Mr. Markey, Ms. 
 Murkowski, and Mr. Merkley) introduced the following bill; which was 
 read twice and referred to the Committee on Health, Education, Labor, 
                              and Pensions

_______________________________________________________________________

                                 A BILL


 
    To amend title XXVII of the Public Health Service Act to apply 
 financial assistance towards the cost-sharing requirements of health 
                insurance plans, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Help Ensure Lower Patient Copays 
Act'' or the ``HELP Copays Act''.

SEC. 2. APPLICATION OF FINANCIAL ASSISTANCE TOWARD COST-SHARING 
              REQUIREMENTS.

    (a) Application Toward Cost-Sharing Requirements.--Section 
2715(g)(1) of the Public Health Service Act (42 U.S.C. 300gg-15(g)(1)) 
is amended by adding at the end the following: ``In developing the 
standards for defining the terms `deductible', `coinsurance', 
`copayment', and `out-of-pocket limit' (as described in paragraph (2)), 
such standards shall provide that such terms include amounts paid by, 
or on behalf of, an individual enrolled in a group health plan or group 
or individual health insurance coverage, including financial assistance 
offered by non-profit organizations and prescription drug 
manufacturers, and that such amounts shall be counted toward such 
deductible, coinsurance, copayment, or limit, respectively.''.
    (b) Conforming Amendments.--
            (1) PPACA.--Section 1302(c)(3) of the Patient Protection 
        and Affordable Care Act (42 U.S.C. 18022(c)(3)) is amended by 
        adding at the end the following new subparagraph:
                    ``(C) Application of terms.--For purposes of 
                subparagraph (A), the terms `deductible', 
                `coinsurance', `copayment', or `similar charge' and any 
                other expenditure described in clause (ii) of such 
                subparagraph shall include amounts paid by, or on 
                behalf of, an individual enrolled in a group health 
                plan or group or individual health insurance coverage, 
                including financial assistance offered by non-profit 
                organizations and prescription drug manufacturers, and 
                such amounts shall be counted toward such deductible, 
                co-insurance, co-payment, charge, or other expenditure, 
                respectively.''.
            (2) PHSA.--Section 2707(b) of the Public Health Service Act 
        (42 U.S.C. 300gg-6(b)) is amended by adding at the end the 
        following new sentence: ``For purposes of the previous 
        sentence, such limitation shall be applied to prescription 
        drugs as if the reference to `essential health benefits' in 
        section 1302(c)(3) of the Patient Protection and Affordable 
        Care Act were a reference to `any item or service covered under 
        the plan included within the prescription drug category of 
        essential health benefits as described in (b)(1)(F) of such 
        section'.''.
            (3) Internal revenue code of 1986 safe harbor for certain 
        amounts applied to deductibles.--Section 223(c)(2) of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new subparagraph:
                    ``(H) Safe harbor for certain amounts applied to 
                deductibles.--In the case of plan years beginning after 
                December 31, 2025, a plan shall not fail to be treated 
                as a high deductible health plan by reason of counting 
                amounts paid by, or on behalf of, an individual, 
                including financial assistance offered by non-profit 
                organizations and prescription drug manufacturers for 
                outpatient prescription drugs, when determining whether 
                the minimum deductible under subparagraph (A) has been 
                satisfied.''.
    (c) Rule of Construction.--The amendments made by this section 
shall --
            (1) apply to standards relating to deductibles, 
        coinsurance, copayments, or limits with respect to prescription 
        drugs that are specialty drugs;
            (2) apply to standards relating to deductibles, 
        coinsurance, copayments, or limits with respect to drugs that 
        are subject to utilization management; and
            (3) not impact the use of utilization management tools, 
        including prior authorization and step therapy.
    (d) Effective Date.--This section, and the amendments made by this 
section, shall apply to group health plans and health insurance issuers 
for plan years beginning on or after January 1, 2026.
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