Congressman Brian Fitzpatrick (PA-1) has introduced the bipartisan Help Ensure Lower Patient (HELP) Copays Act, aimed at reducing prescription drug costs for patients with rare, serious, and chronic conditions. The legislation was announced alongside Representatives Tom Kean, Jr. (R-NJ), Nanette Barragán (D-CA), Mariannette Miller-Meeks (R-IA), Jake Auchincloss (D-MA), and Bonnie Watson Coleman (D-NJ). A companion bill has been introduced in the Senate by Senators Roger Marshall (R-KS) and Tom Kaine (D-VA).
The proposed bill would require insurance companies and Pharmacy Benefit Managers to count copay assistance—whether provided directly by patients or through non-profit organizations or drug manufacturers—toward a patient’s annual deductible and out-of-pocket limit.
“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. 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,” said Fitzpatrick.
The HELP Copays Act seeks to clarify Affordable Care Act requirements so that all payments made “by or on behalf of” patients—including financial aid from nonprofits or drug manufacturers—are counted toward deductibles and out-of-pocket limits. It also aims to close an Essential Health Benefit loophole so that any prescription drug covered by a health plan is defined as “essential,” ensuring related cost-sharing counts toward annual protections.
“Copay assistance programs help make costly medications attainable for Americans who rely on them. Yet under current law, insurers and PBMs can pocket this assistance without lowering patients’ cost-sharing obligations. Our bipartisan legislation will fix that problem by ensuring those savings are passed on to patients. This solution will protect access to essential prescription drugs, reduce overall healthcare costs for families, and hold these health companies accountable,” said Kean, Jr.
“Too many patients are forced to walk away from the pharmacy counter because their out-of-pocket costs are simply too high. The HELP Copays Act is a commonsense, bipartisan solution that ensures financial assistance, from nonprofits or drug manufacturers, actually counts toward a patient’s deductible and copay. As a physician, I know how devastating it is when a patient can’t afford the medication they need. This bill puts patients first by lowering their real, day-to-day costs and stopping insurance companies from shifting more of the burden onto families,” said Miller-Meeks.
“Drug pricing middlemen want patients to pay deductibles twice. That’s not how insurance should work. With this bill, those schemes stop,” said Auchincloss.
“For patients living with complex and chronic diseases, access to prescription drugs that help them manage their condition saves lives, plain and simple. But too many Americans are unable to afford the medications they need because the out-of-pocket costs are too high. This is unacceptable. Americans work hard every day to make sure they can feed their families and take care of their loved ones. They should not be priced out of receiving the life-saving medications they rely on. That is why I am proud to co-lead the HELP Copays Act with Congressman Kean. This bipartisan bill will help working American families afford their prescriptions by putting a stop to harmful practices by insurance companies and Pharmacy Benefit Managers, and ensuring that patients’ copay assistance counts towards their cost-sharing requirements. Because drug affordability is not a blue-state issue or a red-state issue — it is an issue that affects tens of millions across the country and in every state,” said Barragán.
Fitzpatrick has served as U.S Representative for Pennsylvania’s 1st District since 2017 after replacing Mike Fitzpatrick in Congress https://fitzpatrick.house.gov/about. He was born in Philadelphia in 1973 https://bioguide.congress.gov/search/bio/F000466.
The All Copays Count Coalition—a group comprising nearly 90 national patient and provider advocacy organizations—has endorsed this legislation.
