In an effort to make prescription medications more affordable for patients, U.S. Rep. Rodney Davis (R-IL) this week introduced the bipartisan bill Help Ensure Lower Patient Copays Act.
Known as the HELP Copays Act, H.R. 5801, the legislation would prohibit the use of copay accumulator programs, which permit issuers to exclude cost-sharing assistance towards a patient’s out-of-pocket maximum, making it difficult for patients to afford their prescription drugs.
“Making prescription drugs more affordable for everyone is one of my top priorities and a bipartisan goal shared by Congress,” Rep. Davis said.
Rep. Davis introduced H.R. 5801 with bill sponsor U.S. Rep. Donald McEachin (D-VA) on Nov. 1. The measure, if approved, would apply additional payments, discounts, and other financial assistance towards the cost-sharing requirements of health insurance plans, according to the text of the bill. The legislation seeks to ensure insurers cannot exclude the value of pharmaceutical manufacturer cost-sharing assistance from counting toward an enrollee’s annual cost-sharing limit, the congressman’s office explained.
“Especially with the costs of goods and services on the rise, patients shouldn’t have to face complicated financial barriers when purchasing prescription drugs. Every dollar saved counts,” Rep. Davis said.
In the past, when a patient has utilized cost-sharing assistance when paying for prescription drugs, the amount has counted towards a patient’s deductible and maximum out-of-pocket limit, thereby lowering the patient’s costs. But recently, many health plans started designing benefits to exclude cost-sharing assistance from counting towards a patient’s maximum out-of-pocket limit and deductible, according to a factsheet about the bill from the lawmakers.
The problem can be rectified by reversing a policy adopted in the 2021 Notice of Benefit and Payment Parameters (NBPP) during the previous administration, the factsheet said.
“As Americans continue navigating the coronavirus pandemic, we must take steps to protect them from undue out-of-pocket expenses,” Rep. McEachin added.