Please Support the HELP Copays Act!

The HELP Copays Act will help to eliminate barriers to treatment for those with chronic illnesses, including Autoimmune and Autoinflammatory Arthritis. It is a two-part, bipartisan effort to require that health plans count copay assistance payments toward patient cost-sharing requirements -- deductibles and out-of-pocket maximums. This legislation also closes the essential health benefit loophole.

US118HR 830

HELP Copays Act

Last Action

Referred to the Subcommittee on Health.

House • Feb 17, 2023

Latest Version

Introduced in House

Take action now

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Your Message to the legislators

Dear (name and title inserted automatically),

My name is [INSERT NAME] and I am a resident of [INSERT TOWN/DISTRICT NAME]. As your constituent, I write to urge your support for passage of S 1375/HR 830, the Help Ensure Lower Patient (HELP) Copays Act, introduced by Representative Earl L. “Buddy” Carter and Senator Roger Marshall. This important bipartisan legislation will protect vulnerable patients’ access to prescription medications by ensuring that commercial health plans count the value of copay assistance toward patient deductibles.

Many patients, especially those with rare and chronic diseases, rely on copay assistance to afford their medications. However, health insurers are increasingly implementing copay accumulator adjustment program policies that don’t count the value of copay assistance toward a patient’s annual deductible or out-of-pocket maximum. These policies allow health plans to increase their profits by requiring patients to pay the same amount twice to get closer to their annual out-of-pocket limit. A 2024 report from The AIDS Institute (https://aidsinstitute.net/documents/TAI-2024-Report-2.27.pdf) found that two-thirds (66%) of all individual marketplace plans have copay accumulator adjustment policies.

Those living with AiArthritis diseases already face higher-than-average healthcare costs, and our medications are often far costlier than medications for other conditions, and often have few or no alternatives. Because our medications are so expensive - sometimes having copays in the thousands of dollars - we often rely on copay assistance programs to help us afford them. When these assistance programs aren’t counted toward our deductible and out-of-pocket maximums, many of us are forced to forgo the medication, or make a choice to forgo another medical treatment later in the year. When AiArthritis patients miss treatments or medications, many will develop comorbidities due to uncontrolled inflammation. This not only causes pain and suffering for the patient, but increases health care consumption and costs for both the person affected and the health system as a whole.

The HELP Copays Act would prevent insurers and PBMs from profiting by accepting copay assistance payments and therefore protect access to care for people living with chronic illness. I strongly support this legislation and ask that you cosponsor the bill to protect patients from harmful insurer and pharmacy benefit manager (PBM) practices that harm patient access. Thank you for your leadership.