Carter-led bipartisan bill aims to decrease patient copays for prescription drugs

A bipartisan bill recently sponsored by U.S. Rep. Buddy Carter (R-GA) would apply additional payments, discounts, and other financial assistance toward the cost-sharing requirements of health insurance plans to help decrease patients’ out-of-pocket prescription drug costs.

Rep. Carter said in a Feb. 9 statement that he was glad to introduce the legislation alongside colleagues “who share our commitment to make healthcare more affordable.” 

The Help Ensure Lower Patient (HELP) Copays Act, H.R. 830, which the congressman introduced on Feb. 6 with six original cosponsors, including U.S. Reps. Mariannette Miller-Meeks (R-IA), Brian Fitzpatrick (R-PA), and Nanette Barragán (D-CA), aims to protect patients from insurance and pharmacy benefit manager (PBM) practices that raise such drug costs, according to the lawmakers.

“Only health plans and PBMs could take a program designed to reduce patients’ out-of-pocket prescription drug costs and turn it into a money-making machine,” said Rep. Carter. “Especially now, with inflation near 40-year highs, Congress must use all tools at its disposal to help Americans stretch the value of their dollar.”

If enacted, H.R. 830 would prohibit the use of “copay accumulator” schemes that health plans and PBMs developed to exclude the cost-sharing assistance from counting toward a patients’ deductible or out-of-pocket maximum, according to a bill summary provided by Rep. Carter’s office. 

“Health plans and PBMs should not be in the business of forcing families to make a choice between their medicine and their expenses,” said Rep. Barragán. “That’s why I am proud to introduce this bipartisan legislation to protect patients who rely on copay assistance and ensure that prescriptions remain accessible for many families across L.A. County.”

“Copays are designed to make drug costs manageable — there is no reason third-party PBMs should be profiting from this deposit,” Rep. Miller-Meeks added. “Our bill will protect patients and ensure their copays are going toward the cost of their medications.”

The AIDS Institute, the Cancer Support Community, the Arthritis Foundation, the National Hemophilia Foundation, and the National Multiple Sclerosis Society endorsed the bill, which mirrors policy that 16 states and Puerto Rico have enacted to ensure copay assistance counts toward patients’ out-of-pocket costs.