Bipartisan legislation proposed on Dec. 4 by U.S. Rep. Brian Fitzpatrick (R-PA) would make prescription medications more affordable for patients with rare and chronic conditions.
The Help Ensure Lower Patient (HELP) Copays Act, H.R. 6423, would require insurance companies and pharmacy benefit managers (PBMs) to count the value of copay assistance they receive on a patient’s behalf toward cost-sharing requirements to guarantee that payments — whether made directly by a patient or with support from non-profit organizations or prescription drug manufacturers — contribute toward a patient’s annual deductible and out-of-pocket limit as intended.
“For people living with chronic and rare diseases, copay assistance is often the only path to staying on lifesaving treatment. Yet far too many are paying twice, while insurers and PBMs pocket that assistance without ever counting it toward a patient’s costs,” Rep. Fitzpatrick said. “That’s wrong — and it’s exactly what the bipartisan HELP Copays Act corrects. This is common-sense, patient-first reform to lower out-of-pocket costs and ensure every dollar intended to help a patient actually does.”
Rep. Fitzpatrick joined four other original cosponsors, including U.S. Rep. Nanette Barragán (D-CA), to introduce H.R. 6423, which is sponsored by U.S. Rep. Tom Kean, Jr. (R-NJ). Companion legislation was introduced by U.S. Sens. Roger Marshall (R-KS) and Tom Kaine (D-VA) in their chamber.
If enacted, the bill would clarify the Affordable Care Act (ACA) to require that health plans count payments made “by or on behalf of” patients toward deductibles and out-of-pocket limits.
The measure also would close the ACA’s Essential Health Benefit loophole to ensure that any prescription drug covered by a health plan is defined as “essential,” so that all related cost-sharing is counted towards a patient’s annual cost-sharing protections, according to a bill summary provided by the lawmakers.
“This bipartisan bill will help working American families afford their prescriptions by putting a stop to harmful practices by insurance companies and [PBMs], and ensuring that patients’ copay assistance counts towards their cost-sharing requirements,” said Rep. Barragán.