Us Congress 2025-2026 Regular Session

Us Congress Senate Bill SB864 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	II
2	2	119THCONGRESS
3	3	1
4	4	STSESSION S. 864
5	5	To amend title XXVII of the Public Health Service Act to apply financial
6	6	assistance towards the cost-sharing requirements of health insurance
7	7	plans, and for other purposes.
8	8	IN THE SENATE OF THE UNITED STATES
9	9	MARCH5, 2025
10	10	Mr. M
11	11	ARSHALL(for himself, Mr. KAINE, Mr. TILLIS, Mr. MARKEY, Ms. MUR-
12	12	KOWSKI, and Mr. MERKLEY) introduced the following bill; which was read
13	13	twice and referred to the Committee on Health, Education, Labor, and
14	14	Pensions
15	15	A BILL
16	16	To amend title XXVII of the Public Health Service Act
17	17	to apply financial assistance towards the cost-sharing
18	18	requirements of health insurance plans, and for other
19	19	purposes.
20	20	Be it enacted by the Senate and House of Representa-1
21	21	tives of the United States of America in Congress assembled, 2
22	22	SECTION 1. SHORT TITLE. 3
23	23	This Act may be cited as the ‘‘Help Ensure Lower 4
24	24	Patient Copays Act’’ or the ‘‘HELP Copays Act’’. 5
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27	27	•S 864 IS
28	28	SEC. 2. APPLICATION OF FINANCIAL ASSISTANCE TOWARD 1
29	29	COST-SHARING REQUIREMENTS. 2
30	30	(a) A
31	31	PPLICATIONTOWARDCOST-SHARINGREQUIRE-3
32	32	MENTS.—Section 2715(g)(1) of the Public Health Service 4
33	33	Act (42 U.S.C. 300gg–15(g)(1)) is amended by adding at 5
34	34	the end the following: ‘‘In developing the standards for 6
35	35	defining the terms ‘deductible’, ‘coinsurance’, ‘copayment’, 7
36	36	and ‘out-of-pocket limit’ (as described in paragraph (2)), 8
37	37	such standards shall provide that such terms include 9
38	38	amounts paid by, or on behalf of, an individual enrolled 10
39	39	in a group health plan or group or individual health insur-11
40	40	ance coverage, including financial assistance offered by 12
41	41	non-profit organizations and prescription drug manufac-13
42	42	turers, and that such amounts shall be counted toward 14
43	43	such deductible, coinsurance, copayment, or limit, respec-15
44	44	tively.’’. 16
45	45	(b) C
46	46	ONFORMINGAMENDMENTS.— 17
47	47	(1) PPACA.—Section 1302(c)(3) of the Patient 18
48	48	Protection and Affordable Care Act (42 U.S.C. 19
49	49	18022(c)(3)) is amended by adding at the end the 20
50	50	following new subparagraph: 21
51	51	‘‘(C) A
52	52	PPLICATION OF TERMS .—For pur-22
53	53	poses of subparagraph (A), the terms ‘deduct-23
54	54	ible’, ‘coinsurance’, ‘copayment’, or ‘similar 24
55	55	charge’ and any other expenditure described in 25
56	56	clause (ii) of such subparagraph shall include 26
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60	60	amounts paid by, or on behalf of, an individual 1
61	61	enrolled in a group health plan or group or in-2
62	62	dividual health insurance coverage, including fi-3
63	63	nancial assistance offered by non-profit organi-4
64	64	zations and prescription drug manufacturers, 5
65	65	and such amounts shall be counted toward such 6
66	66	deductible, co-insurance, co-payment, charge, or 7
67	67	other expenditure, respectively.’’. 8
68	68	(2) PHSA.—Section 2707(b) of the Public 9
69	69	Health Service Act (42 U.S.C. 300gg–6(b)) is 10
70	70	amended by adding at the end the following new 11
71	71	sentence: ‘‘For purposes of the previous sentence, 12
72	72	such limitation shall be applied to prescription drugs 13
73	73	as if the reference to ‘essential health benefits’ in 14
74	74	section 1302(c)(3) of the Patient Protection and Af-15
75	75	fordable Care Act were a reference to ‘any item or 16
76	76	service covered under the plan included within the 17
77	77	prescription drug category of essential health bene-18
78	78	fits as described in (b)(1)(F) of such section’.’’. 19
79	79	(3) I
80	80	NTERNAL REVENUE CODE OF 1986 SAFE 20
81	81	HARBOR FOR CERTAIN AMOUNTS APPLIED TO 21
82	82	DEDUCTIBLES.—Section 223(c)(2) of the Internal 22
83	83	Revenue Code of 1986 is amended by adding at the 23
84	84	end the following new subparagraph: 24
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88	88	‘‘(H) SAFE HARBOR FOR CERTAIN 1
89	89	AMOUNTS APPLIED TO DEDUCTIBLES .—In the 2
90	90	case of plan years beginning after December 3
91	91	31, 2025, a plan shall not fail to be treated as 4
92	92	a high deductible health plan by reason of 5
93	93	counting amounts paid by, or on behalf of, an 6
94	94	individual, including financial assistance offered 7
95	95	by non-profit organizations and prescription 8
96	96	drug manufacturers for outpatient prescription 9
97	97	drugs, when determining whether the minimum 10
98	98	deductible under subparagraph (A) has been 11
99	99	satisfied.’’. 12
100	100	(c) R
101	101	ULE OFCONSTRUCTION.—The amendments 13
102	102	made by this section shall — 14
103	103	(1) apply to standards relating to deductibles, 15
104	104	coinsurance, copayments, or limits with respect to 16
105	105	prescription drugs that are specialty drugs; 17
106	106	(2) apply to standards relating to deductibles, 18
107	107	coinsurance, copayments, or limits with respect to 19
108	108	drugs that are subject to utilization management; 20
109	109	and 21
110	110	(3) not impact the use of utilization manage-22
111	111	ment tools, including prior authorization and step 23
112	112	therapy. 24
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116	116	(d) EFFECTIVEDATE.—This section, and the amend-1
117	117	ments made by this section, shall apply to group health 2
118	118	plans and health insurance issuers for plan years begin-3
119	119	ning on or after January 1, 2026. 4
120	120	Æ
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