Urge Congress to make all copays count!
Support the Help Ensure Lower Patient (HELP) Copays Act (H.R. 830/S. 1375)
Introduced by Representatives Buddy Carter (R-GA) and Nanette Barragán (D-CA) in February 2023, with a companion bill introduced by Senator Rodger Marshall (R-KS) in April, the HELP Copays Act would prohibit the use of harmful “copay accumulator adjuster programs” (CAAPs).
CAAPs are used by private insurance plans to prevent co-pay assistance from counting towards a patient’s deductible and out-of-pocket maximum. Many people with serious diseases can't afford their medication without copay assistance. These co-pay accumulator programs prevent patients from getting the care and treatment they need.
This bi-partisan bill offers a two-part solution to counter the concerning rise of copay accumulator adjustment programs:
- Updating the Affordable Care Act’s (ACA) definition of cost-sharing to require that all out-of-pocket payments made by or on behalf of a patient count toward the patient’s deductible and out-of-pocket limit. This would end copay accumulator programs in marketplace exchange insurance plans.
- Stipulating that any item or service covered by an employer health plan is part of the essential health benefits (EHB) package and therefore the plan must count any cost sharing toward patients’ annual limits. This would end the ACA’s EHB loophole that allows plans to deem certain categories of drugs as non-essential.
Urge Congress to make all copays count!
Support the Help Ensure Lower Patient (HELP) Copays Act (H.R. 830/S. 1375)
Introduced by Representatives Buddy Carter (R-GA) and Nanette Barragán (D-CA) in February 2023, with a companion bill introduced by Senator Rodger Marshall (R-KS) in April, the HELP Copays Act would prohibit the use of harmful “copay accumulator adjuster programs” (CAAPs).
CAAPs are used by private insurance plans to prevent co-pay assistance from counting towards a patient’s deductible and out-of-pocket maximum. Many people with serious diseases can't afford their medication without copay assistance. These co-pay accumulator programs prevent patients from getting the care and treatment they need.
This bi-partisan bill offers a two-part solution to counter the concerning rise of copay accumulator adjustment programs:
- Updating the Affordable Care Act’s (ACA) definition of cost-sharing to require that all out-of-pocket payments made by or on behalf of a patient count toward the patient’s deductible and out-of-pocket limit. This would end copay accumulator programs in marketplace exchange insurance plans.
- Stipulating that any item or service covered by an employer health plan is part of the essential health benefits (EHB) package and therefore the plan must count any cost sharing toward patients’ annual limits. This would end the ACA’s EHB loophole that allows plans to deem certain categories of drugs as non-essential.