Help Ensure Lower Patient Copays Act Reintroduced
The bipartisan legislation known as the HELP Copays Act was reintroduced to ensure patients can access and afford the medications prescribed by their doctors.
On March 7, 2025, Sens. Roger Marshall (R-Kansas) and Tim Kaine (D-Virginia) reintroduced the Help Ensure Lower Patient (HELP) Copays Act (S.864). This bipartisan legislation will ensure vulnerable patients can access and afford the necessary and life-saving medications prescribed by their doctors.
In recent years, patients living with chronic conditions, including arthritis, have been subjected to harmful "copay diversion programs," which include copay accumulators and maximizers. When patients utilize copay assistance to pay their copayments, insurers and PBMs won't count those payments toward the patient's annual deductible and out-of-pocket maximums. When the assistance is exhausted, patients will be faced with hundreds or thousands of dollars of out-of-pocket costs, even though they should have already hit their yearly maximum.
This legislation would:
• Require health plans to count the value of copay assistance toward patient cost-sharing requirements; and
• Clarify the Affordable Care Act's (ACA) annual out-of-pocket limit applies to all prescription drugs covered in a health plan. This requires all covered drugs be defined as "essential," prohibiting "copay maximizers."
The Arthritis Foundation continues to support the HELP Copays Act. As the legislation was reintroduced, we submitted a letter to Congress, thanking the sponsors for their focus on this important issue. The letter can be found here.
In recent years, patients living with chronic conditions, including arthritis, have been subjected to harmful "copay diversion programs," which include copay accumulators and maximizers. When patients utilize copay assistance to pay their copayments, insurers and PBMs won't count those payments toward the patient's annual deductible and out-of-pocket maximums. When the assistance is exhausted, patients will be faced with hundreds or thousands of dollars of out-of-pocket costs, even though they should have already hit their yearly maximum.
This legislation would:
• Require health plans to count the value of copay assistance toward patient cost-sharing requirements; and
• Clarify the Affordable Care Act's (ACA) annual out-of-pocket limit applies to all prescription drugs covered in a health plan. This requires all covered drugs be defined as "essential," prohibiting "copay maximizers."
The Arthritis Foundation continues to support the HELP Copays Act. As the legislation was reintroduced, we submitted a letter to Congress, thanking the sponsors for their focus on this important issue. The letter can be found here.
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