Requires any amount paid by or on behalf of an insured person — including copay/cost‑sharing help from nonprofits or drug manufacturers — to be counted toward that enrollee’s deductible, coinsurance, copayment, or similar out‑of‑pocket requirement under health coverage. It amends parts of the Public Health Service Act, the Affordable Care Act, and the Internal Revenue Code and creates a tax‑code safe harbor so that counting those payments will not make a plan cease to qualify as a high‑deductible health plan (HDHP) for plan years beginning in 2026. The change explicitly covers specialty drugs and drugs subject to utilization management while preserving tools like prior authorization and step therapy.