Sponsors (44)
The bill lowers out-of-pocket burdens and preserves HSA eligibility for many patients with high drug costs, but shifts costs and administrative burdens onto plans/employers and risks higher overall drug spending through manufacturer-driven steering.
People with high prescription costs (including users of specialty drugs) will have manufacturer or charity assistance count toward their deductible and out-of-pocket limits, lowering their immediate out-of-pocket spending and — for enrollees in high-deductible health plans after 2025 — preserving HSA eligibility.
Patients using specialty drugs or drugs subject to utilization management will face clearer, more consistent cost-sharing rules, which helps ensure equitable treatment and reduces surprises for those needing high-cost therapies.
Employers, insurers, and taxpayers may face higher overall plan costs that could be passed to consumers as higher premiums or other cost‑shifting.
Pharmaceutical manufacturer patient-support programs could be used to steer patients toward particular drugs, potentially increasing overall drug spending even though patients see lower out-of-pocket costs.
Plans, employers, and health systems will incur administrative complexity and compliance costs to track and apply third-party payments toward cost-sharing starting in plan years 2026, creating operational burdens and potential implementation challenges.
Based on analysis of 2 sections of legislative text.
Requires financial assistance (including manufacturer coupons and charity help) to count toward deductibles, copays, and out-of-pocket limits and preserves HDHP/HSA status.
Introduced December 4, 2025 by Thomas Kean · Last progress December 4, 2025
Requires that patient financial assistance — including nonprofit help and manufacturer coupons for prescription drugs — be counted toward an enrollee’s deductible, coinsurance, copayment, or other out-of-pocket limits for group health plans and individual market coverage. Also amends federal rules so such assistance will not disqualify a plan as a high-deductible health plan (HDHP) for HSA purposes, and makes these rules effective for plan years beginning on or after January 1, 2026.