I 
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. BARRAGA´N, Mrs. MILLER-MEEKS, Mr. 
AUCHINCLOSS, Mr. FITZPATRICK, and Mrs. WATSON COLEMAN) intro-
duced 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 Representa-
tives 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’’. 
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SEC. 2. APPLICATION OF FINANCIAL ASSISTANCE TOWARD 
COST-SHARING REQUIREMENTS. 
(a) APPLICATION TOWARD COST-SHARING REQUIRE-
MENTS.—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 insur-
ance coverage, including financial assistance offered by 
non-profit organizations and prescription drug manufac-
turers, and that such amounts shall be counted toward 
such deductible, coinsurance, copayment, or limit, respec-
tively.’’. 
(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 pur-
poses of subparagraph (A), the terms ‘deduct-
ible’, ‘coinsurance’, ‘copayment’, or ‘similar 
charge’ and any other expenditure described in 
clause (ii) of such subparagraph shall include 
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amounts paid by, or on behalf of, an individual 
enrolled in a group health plan or group or in-
dividual health insurance coverage, including fi-
nancial assistance offered by non-profit organi-
zations 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 Af-
fordable Care Act were a reference to ‘any item or 
service covered under the plan included within the 
prescription drug category of essential health bene-
fits 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: 
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‘‘(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 manage-
ment tools, including prior authorization and step 
therapy. 
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(d) EFFECTIVE DATE.—This section, and the amend-
ments made by this section, shall apply to group health 
plans and health insurance issuers for plan years begin-
ning on or after January 1, 2026. 
Æ 
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