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 full analysis lists 5 implications of this text.

Who stands to gain

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