Drug makers' copay assistance now counts toward your deductible—but premiums may rise

What it does

This bill allows financial assistance from nonprofits and drug manufacturers to count toward patients' insurance cost-sharing requirements (deductibles, copayments, coinsurance, out-of-pocket limits). Starting in 2026, when a patient receives copay assistance from a manufacturer or nonprofit, that assistance will be credited toward their deductible and out-of-pocket maximum, potentially lowering their total out-of-pocket costs. The bill also creates a safe harbor allowing high-deductible health plans to count manufacturer copay assistance toward their minimum deductible requirement.

Why we flagged it

The bill's operative mechanism is to allow drug manufacturers' copay assistance to count toward patient cost-sharing thresholds. While framed as patient relief, the primary beneficiary is the pharmaceutical industry: manufacturers gain a powerful incentive to offer copay assistance (which now accelerates patient cost-sharing exhaustion and triggers insurer cost-sharing obligations), effectively shifting costs from patients to insurers and ultimately to the broader premium-paying population.

What the text implies

• Manufacturers gain incentive to offer copay assistance strategically for high-cost drugs, knowing assistance now counts toward deductibles—this may concentrate assistance on expensive specialty drugs rather than broadly benefiting patients on lower-cost medications.
• Insurers facing faster cost-sharing exhaustion may respond by raising premiums, reducing covered benefits, or tightening utilization management (prior authorization, step therapy)—costs shift from assisted patients to unassisted patients and the broader insured pool.
• The safe harbor for high-deductible health plans (HSAs) may allow manufacturers to subsidize copays on specialty drugs while patients still satisfy HSA-eligible deductibles, creating a tax-advantaged pathway for manufacturer-funded cost-sharing that benefits higher-income HSA users disproportionately.
• Patients without access to manufacturer copay programs (generic drugs, older medications, drugs from smaller manufacturers) may face higher premiums or reduced coverage as insurers adjust to faster cost-sharing exhaustion driven by assisted patients.
• The bill does not restrict utilization management tools (prior authorization, step therapy), meaning insurers retain gatekeeping power even as copay assistance counts toward deductibles—patients may still face delays or denials despite lower out-of-pocket costs.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Patients receive immediate relief: copay assistance now counts toward their deductibles and out-of-pocket limits, reducing their direct spending. However, insurers facing faster cost-sharing exhaustion may raise premiums or reduce coverage generosity, shifting costs to the broader insured population and potentially harming those without manufacturer assistance access.

Who stands to gain

• pharmaceutical manufacturers
• specialty drug makers
• prescription drug companies offering copay assistance programs

Named in the bill

Public Health Service Act, Patient Protection and Affordable Care Act (PPACA), Internal Revenue Code Section 223, high-deductible health plans (HDHPs), health savings accounts (HSAs), prescription drug manufacturers, nonprofit organizations, health insurance issuers

Where it stands

28 cosponsors: 21 Democrats, 7 Republicans.

• Mar 5, 2025 — Introduced · Congress.gov: “Introduced in Senate”
• Mar 5, 2025 — Referred to Senate Committee on Health, Education, Labor, and Pensions · Congress.gov: “Read twice and referred to the Committee on Health, Education, Labor, and Pensions”
• Mar 19, 2026 — Hearing held · Congress.gov: “Committee on Health, Education, Labor, and Pensions. Hearings held”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

35 lobbying clients named this bill on 47 disclosure filings across 4 quarters, Jun 2025 to Jun 2026. Those filings disclosed $31,252,068 in lobbying spend. A filing names 5 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 98% of bills with at least one filing.

Roger Marshall, the sponsor, reported $1,777,391 in PAC receipts in the 2026 cycle. $33,000 of that came from 5 PACs tied to these lobbying clients.

• Pharmaceutical Research and Manufacturers of America — $15,770,000 on 2 filings
• Abbvie Inc. — $2,490,000 on 2 filings
• Vertex Pharmaceuticals Incorporated — $2,310,000 on 2 filings
• Biogen — $1,830,000 on 2 filings
• Johnson & Johnson Services Inc — $1,440,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.