H.R. 6423

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6423 Introduced in House (IH)]

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119th CONGRESS
1st Session
H. R. 6423

To amend title XXVII of the Public Health Service Act to apply 
financial assistance towards the cost-sharing requirements of health 
insurance plans, and for other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

December 4, 2025

Mr. Kean (for himself, Ms. Barragan, Mrs. Miller-Meeks, Mr. 
Auchincloss, Mr. Fitzpatrick, and Mrs. Watson Coleman) introduced the 
following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committee on Ways and Means, for a 
period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
committee concerned

_______________________________________________________________________

A BILL

To amend title XXVII of the Public Health Service Act to apply 
financial assistance towards the cost-sharing requirements of health 
insurance plans, and for other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Help Ensure Lower Patient Copays 
Act'' or the ``HELP Copays Act''.

SEC. 2. APPLICATION OF FINANCIAL ASSISTANCE TOWARD COST-SHARING 
REQUIREMENTS.

(a) Application Toward Cost-Sharing Requirements.--Section 
2715(g)(1) of the Public Health Service Act (42 U.S.C. 300gg-15(g)(1)) 
is amended by adding at the end the following: ``In developing the 
standards for defining the terms `deductible', `coinsurance', 
`copayment', and `out-of-pocket limit' (as described in paragraph (2)), 
such standards shall provide that such terms include amounts paid by, 
or on behalf of, an individual enrolled in a group health plan or group 
or individual health insurance coverage, including financial assistance 
offered by non-profit organizations and prescription drug 
manufacturers, and that such amounts shall be counted toward such 
deductible, coinsurance, copayment, or limit, respectively.''.
(b) Conforming Amendments.--
(1) PPACA.--Section 1302(c)(3) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18022(c)(3)) is amended by 
adding at the end the following new subparagraph:
``(C) Application of terms.--For purposes of 
subparagraph (A), the terms `deductible', 
`coinsurance', `copayment', or `similar charge' and any 
other expenditure described in clause (ii) of such 
subparagraph shall include amounts paid by, or on 
behalf of, an individual enrolled in a group health 
plan or group or individual health insurance coverage, 
including financial assistance offered by non-profit 
organizations and prescription drug manufacturers, and 
such amounts shall be counted toward such deductible, 
co-insurance, co-payment, charge, or other expenditure, 
respectively.''.
(2) PHSA.--Section 2707(b) of the Public Health Service Act 
(42 U.S.C. 300gg-6(b)) is amended by adding at the end the 
following new sentence: ``For purposes of the previous 
sentence, such limitation shall be applied to prescription 
drugs as if the reference to `essential health benefits' in 
section 1302(c)(3) of the Patient Protection and Affordable 
Care Act were a reference to `any item or service covered under 
the plan included within the prescription drug category of 
essential health benefits as described in (b)(1)(F) of such 
section'.''.
(3) Internal revenue code of 1986 safe harbor for certain 
amounts applied to deductibles.--Section 223(c)(2) of the 
Internal Revenue Code of 1986 is amended by adding at the end 
the following new subparagraph:
``(H) Safe harbor for certain amounts applied to 
deductibles.--In the case of plan years beginning after 
December 31, 2025, a plan shall not fail to be treated 
as a high deductible health plan by reason of counting 
amounts paid by, or on behalf of, an individual, 
including financial assistance offered by non-profit 
organizations and prescription drug manufacturers for 
outpatient prescription drugs, when determining whether 
the minimum deductible under subparagraph (A) has been 
satisfied.''.
(c) Rule of Construction.--The amendments made by this section 
shall--
(1) apply to standards relating to deductibles, 
coinsurance, copayments, or limits with respect to prescription 
drugs that are specialty drugs;
(2) apply to standards relating to deductibles, 
coinsurance, copayments, or limits with respect to drugs that 
are subject to utilization management; and
(3) not impact the use of utilization management tools, 
including prior authorization and step therapy.
(d) Effective Date.--This section, and the amendments made by this 
section, shall apply to group health plans and health insurance issuers 
for plan years beginning on or after January 1, 2026.
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