In recent years, patients with chronic conditions, including cancer, have faced harmful "copay diversion programs" such as copay accumulators and maximizers. These programs prevent copay assistance payments from counting toward a patient's annual deductible and out-of-pocket maximums. Once the assistance runs out, patients are left with hundreds or thousands of out-of-pocket costs, even though they should have already reached their yearly maximum.
On March 7, 2025, Sens. Roger Marshall (R-Kansas) and Tim Kaine (D-Virginia) reintroduced the Help Ensure Lower Patient (HELP) Copays Act (S.864). This bipartisan legislation will ensure vulnerable patients can access and afford the necessary and life-saving medications prescribed by their doctors.
Specifically, this legislation would:
- Require health plans to count the value of copay assistance toward patient cost-sharing requirements; and
- Clarify that the Affordable Care Act's (ACA) annual out-of-pocket limit applies to all prescription drugs covered in a health plan. This requires all covered drugs be defined as "essential," prohibiting "copay maximizers"
AONN+, led by our Policy & Advocacy Committee, has joined with nearly 100 members of the All Copays Count Coalition to submit a letter to Congress, thanking the sponsors for their focus on this important issue. The letter can be found here.
Read the press release from Senator Marshall.
