Your Questions About the HELP Copays Act, Answered

If you’ve been following the fight for affordable prescription drug coverage, you’ve probably heard people talking about “copay accumulators” and the HELP Copays Act. It’s a complicated issue with a lot of moving parts — court rulings, federal agencies, state laws, and a bill working its way through Congress. Here are answers to the questions we hear most often.

What is the HELP Copays Act?

The HELP Copays Act (H.R. 6423 in the House, S. 864 in the Senate) is bipartisan legislation that would require health plans to count all qualified third-party financial assistance — including charitable assistance and manufacturer copay support — toward a patient’s annual deductible and out-of-pocket maximum.

In plain terms: if someone helps you pay for your medication, that help should count toward what you owe for the year. Right now, many insurance plans don’t let it count, which is where the trouble starts.

Why did this become a problem in the first place?

Since the law changed in 2010 to guarantee that people with pre-existing conditions could get health coverage, there have been ongoing efforts to find loopholes that shift costs back onto patients or limit what their coverage actually pays for. Copay accumulator programs are one of those workarounds — a way for plans to collect the benefit of a patient’s financial assistance without it reducing what the patient owes.

Haven’t courts already ruled on this?

Yes — and this is one of the more encouraging parts of the story. Patient advocacy groups have challenged federal rules, issued under both Democratic and Republican administrations, that allowed copay accumulator programs to spread. Federal courts have repeatedly found the practice unlawful and have directed Health and Human Services (HHS) to revise its policy.

New HHS rules are expected, but the process is uncertain — largely because it was HHS’s own earlier rule that the courts struck down. That’s part of why advocates argue a court win isn’t enough on its own.

If courts already say it’s illegal, why do we still need a new law?

Because a favorable court ruling or a new regulation can be undone. Rules can be rewritten again by a future administration, and legal interpretations can shift. Passing the HELP Copays Act would settle the matter in federal law itself, closing the door on the kind of regulatory back-and-forth that got us here. As advocates put it, if Congress changes the underlying law, there’s no flexibility or loophole left for the practice to continue.

Who supports the HELP Copays Act?

It has genuine bipartisan momentum. Accessia Health works alongside many other patient advocacy organizations as part of the All Copays Count Coalition to build support for the bill.

In a previous Congress, the House version of the bill drew more than 150 cosponsors. If a bill like this reaches 218 cosponsors — a majority of the House — before the end of the year, it can be brought to a vote through a procedural tool called a “discharge petition,” even without leadership scheduling it directly.

Have any states already done something about this?

Yes. About half of U.S. states have passed their own laws regulating copay accumulators. That’s meaningful protection for patients in those states, but it also creates an uneven patchwork — your protections can depend entirely on your zip code. A federal law would close those gaps and guarantee the same protection everywhere.

What can I do to help?

Advocacy from real patients and families makes a measurable difference on legislation like this. A few ways to get involved with Accessia Health include:

Every cosponsor and every voice adds momentum toward finally giving patients a lasting, nationwide guarantee that the help they receive makes a difference.

Read more: Policy