Bipartisan HELP Copays Act Targets Prescription Drug Cost Relief

The HELP Copays Act, introduced by Congressman Brian Fitzpatrick and a bipartisan group of lawmakers, aims to address the issue of prescription drug affordability for patients with rare, serious, and chronic conditions. The legislation mandates that insurance companies and Pharmacy Benefit Managers (PBMs) count the value of copay assistance towards patients' annual deductibles and out-of-pocket limits. This ensures that financial support from nonprofit organizations or drug manufacturers directly benefits patients by reducing their actual cost-sharing obligations. Currently, many insurers and PBMs do not apply these copay assistance payments toward patients' cost-sharing requirements, effectively making patients pay twice while insurers benefit from the assistance. The bipartisan nature of this bill highlights its focus on patient-centered healthcare reform. It seeks to close a gap in insurance practices that allows middlemen to bypass the financial relief efforts intended for patients. Lawmakers emphasized the need for common-sense reforms that guarantee every dollar of copay assistance contributes to lowering patients' out-of-pocket expenses, ultimately enhancing access to essential medications. Members of Congress supporting the HELP Copays Act underscored how the legislation would protect access to life-saving treatments and reduce overall healthcare expenses for families. The bill responds to real-world challenges faced by patients who often must forego necessary medications due to cost barriers. By compelling insurers and PBMs to count copay assistance toward deductibles and out-of-pocket maximums, the legislation aims to hold these entities accountable and prevent financial burdens from unjustly shifting to patients. The bill has garnered support from nearly 90 national patient and provider advocacy groups under the All Copays Count Coalition, reflecting broad stakeholder interest in reforming copay assistance policies. This coalition's endorsement indicates significant industry and advocacy engagement around improving prescription drug affordability and insurance cost-sharing transparency. This legislative initiative builds on ongoing efforts by Congressman Fitzpatrick to promote affordable healthcare and reduce prescription drug costs. It represents a targeted strategy to improve insurance compliance regarding copay assistance, with potential nationwide impact given its bipartisan backing and diverse congressional sponsorship. The legislation also highlights evolving regulatory and payer/provider dynamics that influence patient access to medications and cost management in the insurance sector.