The National Scleroderma Foundation is very excited to share that one of the key pieces of legislation we have been supporting this year has been reintroduced in the U.S. House of Representatives.
The Help Ensure Lower Patient (HELP) Copays Act is a piece of legislation designed to make life-saving prescription medications more affordable for people with rare and chronic health conditions.
For patients, this bipartisan legislation requires health plans to count the value of copay assistance toward patient cost sharing requirements.
How the HELP Copays Act Can Lower Costs
Many patients facing rare and chronic disease rely on financial assistance to cover copays for medication. In some states, when a patient uses copay assistance to cover the cost of medications, the insurance provider may not count that payment towards the patient’s overall deductible or out-of-pocket expenses.
Imagine a hypothetical patient who has copay assistance that will cover $500 each month towards the cost of medication for six months. Imagine the patient also has insurance that has a $4,000 deductible. At the end of the six months, the patient would have used assistance to meet $3,000 worth of medical expenses. However, some insurance providers will not count that $3,000 towards the patient’s deductible. The patient would still have to pay $4,000 in out-of-pocket expenses before insurance begins to cover the medication.
The HELP Copays Act creates more affordable access to healthcare by ensuring all payments, whether they come directly from the patient or with help from non-profits or manufacturers, count towards the patient’s annual out-of-pocket limit and deductible.
The legislation (HR 6423) was introduced in the house by representatives Jake Auchincloss (D-MA), Nanette Barragán (D-CA), Brian Fitzpatrick (R-PA), Tom Kean, Jr. (R-NJ), Mariannette Miller-Meeks (R-IA), and Bonnie Watson Coleman (D-NJ). There is an identical bill in the Senate (S.864).
Foundation advocates are encouraged to continue to support this legislation in conversations with their representatives and encourage others in their community to contact a legislator about supporting this bill.
At this time, the legislation is still only introduced in each chamber of Congress; the bills still need to be brought to a vote and passed before becoming law.