,,ii  #aaith ,,congress  #ast ,session  
,s4 #hfd  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,march #e1 #bjbe,mr4
 ,marshall 7for himself1 ,mr4 ,kaine1   
,mr4 ,tillis1 ,mr4 ,markey1 ,ms4        
,murkowski1 and ,mr4 ,merkley7          
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,health1 ,education1      
,labor1 and ,pensions  ,a ,,bill  ,to   
amend title ,,xxvii of the ,public      
,health ,service ,act to apply financial
 assistance towards the cost-sharing    
requirements of health insurance plans1 
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,help ,ensure ,lower ,patient ,copays   
,act or the ,,help ,copays ,act4  #b4   
,application of financial assistance    
toward cost-sharing requirements  7a7   
,application toward cost-,sharing       
requirements ,section #bgae7;g77#a7 of  
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #cjj;gg-#ae7;g77#a77 is       
amended by adding at the end the        

following3 ,in developing the standards 
for defining the terms deductible1      
coinsurance1 copayment1 and             
out-of-pocket limit 7as described in    
paragraph 7#b771 such standards shall   
provide that such terms include amounts 
paid by1 or on behalf of1 an individual 
enrolled in a group health plan or group
 or individual health insurance         
coverage1 including financial assistance
 offered by non-profit organizations and
 prescription drug manufacturers1 and   
that such amounts shall be counted      
toward such deductible1 coinsurance1    
copayment1 or limit1 respectively44  7b7
 ,conforming amendments  7#a7 ,,ppaca   
,section #acjb7;c77#c7 of the ,patient  
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjbb7;c77#c77 is       
amended by adding at the end the        
following new subparagraph3  7,c7       
,application of terms ,for purposes of  
subparagraph 7,a71 the terms deductible1
 coinsurance1 copayment1 or similar     
charge and any other expenditure        

described in clause 7ii7 of such        
subparagraph shall include amounts paid 
by1 or on behalf of1 an individual      
enrolled in a group health plan or group
 or individual health insurance         
coverage1 including financial assistance
 offered by non-profit organizations and
 prescription drug manufacturers1 and   
such amounts shall be counted toward    
such deductible1 co-insurance1          
co-payment1 charge1 or other            
expenditure1 respectively4  4  7#b7     
,,phsa ,section #bgjg7;b7 of the ,public
 ,health ,service ,act 7#db ,u4,s4,c4   
#cjj;gg-#f7;b77 is amended by adding at 
the end the following new sentence3 ,for
 purposes of the previous sentence1 such
 limitation shall be applied to         
prescription drugs as if the reference  
to essential health benefits in section 
#acjb7;c77#c7 of the ,patient           
,protection and ,affordable ,care ,act  
were a reference to any item or service 
covered under the plan included within  
the prescription drug category of       

essential health benefits as described  
in 7b77#a77;,f7 of such section44  7#c7 
,internal ,revenue ,code of #aihf safe  
harbor for certain amounts applied to   
deductibles ,section #bbc7;c77#b7 of the
 ,internal ,revenue ,code of #aihf is   
amended by adding at the end the        
following new subparagraph3  7,h7 ,safe 
harbor for certain amounts applied to   
deductibles ,in the case of plan years  
beginning after ,december #ca1 #bjbe1 a 
plan shall not fail to be treated as a  
high deductible health plan by reason of
 counting amounts paid by1 or on behalf 
of1 an individual1 including financial  
assistance offered by non-profit        
organizations and prescription drug     
manufacturers for outpatient            
prescription drugs1 when determining    
whether the minimum deductible under    
subparagraph 7,a7 has been satisfied4  4
  7c7 ,rule of construction ,the        
amendments made by this section shall --
 7#a7 apply to standards relating to    
deductibles1 coinsurance1 copayments1 or

 limits with respect to prescription    
drugs that are specialty drugs2  7#b7   
apply to standards relating to          
deductibles1 coinsurance1 copayments1 or
 limits with respect to drugs that are  
subject to utilization management2 and  
7#c7 not impact the use of utilization  
management tools1 including prior       
authorization and step therapy4  7d7    
,effective date ,this section1 and the  
amendments made by this section1 shall  
apply to group health plans and health  
insurance issuers for plan years        
beginning on or after ,january #a1      
#bjbf4