Financial Aid for Drugs Must Count Towards Patient Deductibles and Copays.
This law requires health insurers to count financial assistance, such as grants from non-profits or drug manufacturer copay cards, directly toward a patient's annual cost-sharing requirements (deductibles, copayments, and out-of-pocket maximums). This change prevents insurers from using "copay accumulator" programs, ensuring that patients reach their annual spending limits faster, significantly lowering their overall healthcare costs, particularly for expensive specialty drugs. The provisions take effect starting January 1, 2026.
Key points
All financial assistance received for prescription drugs must be applied toward your deductible, copayment, and annual out-of-pocket maximum.
The rule specifically targets specialty drugs and drugs requiring utilization management (like prior authorization).
The law includes a safe harbor provision to ensure that High Deductible Health Plans (HDHPs) remain eligible for Health Savings Accounts (HSAs).
Status:
Introduced
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