Sponsors (26)
The bill reduces patients' out‑of‑pocket exposure and preserves HSA access by counting third‑party drug assistance toward cost‑sharing, but shifts short‑term costs onto plans and risks reducing or reshaping assistance and increasing administrative barriers to access.
Patients with high prescription needs (e.g., people with chronic conditions and low‑income individuals) will see manufacturer and nonprofit copay/assistance count toward their deductibles and out‑of‑pocket limits, lowering their immediate out‑of‑pocket spending for covered drugs and services.
Enrollees facing very expensive specialty drugs will reach their out‑of‑pocket maximums sooner, limiting catastrophic spending and reducing financial risk from high‑cost therapies.
Clarifying a safe harbor for high‑deductible health plans preserves access to Health Savings Accounts while allowing third‑party assistance to count toward cost‑sharing, avoiding disqualification of HDHPs and protecting HSA eligibility for middle‑class families.
Employers and insurers may incur higher short‑term plan costs if third‑party assistance must be applied to cost‑sharing, which could lead to higher premiums or changes in plan design that affect many enrollees.
Drug manufacturers and nonprofit assistance programs might reduce or restructure their patient‑support payments if those payments must be applied to patient cost‑sharing, potentially decreasing available aid for some patients who currently rely on it.
Insurers could respond by tightening utilization management, prior authorization, or other administrative controls to contain costs, which may make obtaining some therapies administratively harder for affected patients.
Based on analysis of 2 sections of legislative text.
Requires third‑party financial assistance (including nonprofit and manufacturer payments) to count toward deductibles, copays, coinsurance, and out‑of‑pocket limits and adds an HSA safe harbor.
Introduced March 5, 2025 by Roger Wayne Marshall · Last progress March 5, 2025
Requires group and individual health plans to count payments made by or on behalf of an enrollee — including contributions from nonprofit patient assistance programs and prescription drug manufacturers — toward plan deductibles, copayments, coinsurance, and out‑of‑pocket maximums. Adds a tax-code safe harbor so counting that assistance will not cause a plan to lose status as a high‑deductible health plan for health savings account (HSA) purposes. Applies to specialty drugs and drugs subject to utilization management while preserving prior authorization, step therapy, and similar tools. The rule takes effect for plan years beginning on or after January 1, 2026.