Representatives Tom Kean, Jr. (R-NJ), Nanette Barragán (D-CA), Mariannette Miller-Meeks (R-IA), Jake Auchincloss (D-MA), Brian Fitzpatrick (R-PA), and Bonnie Watson Coleman (D-NJ) have reintroduced the Help Ensure Lower Patient (HELP) Copays Act in Congress. The bill aims to make prescription medications more affordable for patients with rare, serious, and chronic conditions by changing how insurance companies and Pharmacy Benefit Managers (PBMs) handle copay assistance.
Under the proposed legislation, insurers and PBMs would be required to count the value of copay assistance received on a patient’s behalf toward that patient’s cost-sharing requirements. This includes payments made directly by patients or with help from non-profit organizations and drug manufacturers, ensuring these contributions go toward annual deductibles and out-of-pocket limits.
Congressman Tom Kean, Jr., who has represented New Jersey’s 7th district since 2023 after serving in both the New Jersey General Assembly and Senate, stated: “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.”
Rep. Barragán added: “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.”
Congresswoman Miller-Meeks commented: “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.”
Congressman Auchincloss said: “Drug pricing middlemen want patients to pay deductibles twice. That’s not how insurance should work. With this bill, those schemes stop.”
Congressman Fitzpatrick stated: “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.”
The HELP Copays Act seeks two main changes:
– It would clarify provisions in the Affordable Care Act so health plans must count payments made “by or on behalf of” patients—including financial aid from nonprofits or drug makers—toward cost-sharing requirements.
– It would close an ACA loophole related to Essential Health Benefits so any covered prescription drug qualifies as “essential,” meaning all related cost-sharing applies toward annual limits.
A companion Senate bill was introduced earlier this year by Senators Roger Marshall (R-KS) and Tom Kaine (D-VA). The legislation has been endorsed by nearly 90 national patient advocacy groups through the All Copays Count Coalition.
Thomas Kean Jr., born in Livingston in 1968 and currently residing in Westfield,has served as U.S Representative for New Jersey’s 7th District since 2023. He previously held positions in both chambers of New Jersey’s legislature.He graduated from Dartmouth College.
