• Pharmaceutical manufacturers may offer copay assistance coupons to patients to help offset the cost of their prescriptions. These programs are intended to limit patients’ out-of-pockets costs.
• Health insurers and pharmacy benefit managers (PBMs) have developed copay accumulator programs that prevent copay assistance benefits from being applied toward a patient’s deductible or out-of-pocket maximum.
• Once copay assistance has run out, patients are often surprised to find that they must pay hundreds or even thousands of additional dollars to continue the drug therapy or to obtain other medicines or services.
• Insurer will not count any cost-sharing toward the patient’s deductible and out-of-pocket maximum.

S. 846/H.R. 6423The Help Ensure Lower Patient (HELP) Copays Act Requires health insurance plans to apply third-party payments, financial assistance, discounts, product vouchers, and other reductions in out-of-pocket expenses toward a patients’ cost-sharing requirements. The Bill: 

• Requires health plans to count the value of copay assistance toward patient cost-sharing requirements.
• This would bring much-needed relief to financially vulnerable individuals by ensuring that all payments—whether they come directly out of a patient’s pocket or with the help of copay assistance—count towards their out-of-pocket costs.
• Ends a practice by which many employer health plans deem certain covered drugs as “nonessential,”