Sponsors (14)
The bill makes inhalers substantially more affordable and accessible for people with asthma or COPD (including Medicare beneficiaries and the uninsured) but shifts costs and administrative burdens onto insurers, employers, providers, and the health system, which could raise premiums or complicate plan operations.
People with asthma or COPD — including low‑income enrollees — would pay no more than $15 per 30‑day supply for covered inhalers, lowering their out‑of‑pocket drug costs.
Medicare beneficiaries would avoid Part B and Part D deductibles for specified inhaler products and face reduced cost‑sharing for those inhalers.
Uninsured patients could obtain covered inhalers from program‑registered providers with out‑of‑pocket liability capped at $15 per month through an HHS payment program, improving access for people without coverage.
Insurers and employers may face higher plan costs to cover lower patient cost‑sharing, which could lead to higher insurance premiums or reduced benefits for workers and families over time.
Manufacturers, pharmacies, and providers could receive lower reimbursements or face payment disputes because Medicare payments are tied to the lesser of actual charges or established amounts, creating financial pressure on health providers and suppliers.
Plans that wish to preserve Health Savings Account–eligible high‑deductible health plan (HDHP) status may still need administrative changes despite the safe harbor, adding plan design complexity for employers and administrators.
Based on analysis of 2 sections of legislative text.
Requires group and individual health plans to cover inhaler drugs and related devices with no deductible and cost‑sharing capped at $15 per 30‑day supply.
Official title: To amend title XXVII of the Public Health Service Act, the Internal Revenue Code of 1986, and the Employee Retirement Income Security Act of 1974 to reduce patient cost sharing for prescription drug inhaler products used to treat breathing disorders such as asthma and chronic obstructive pulmonary disease, and for other purposes.
Introduced September 10, 2025 by Kweisi Mfume · Last progress September 10, 2025
Requires group and individual health plans to cover a broad set of inhaler drugs and related administration equipment without a deductible and with patient cost-sharing capped at $15 per 30‑day supply; any permitted cost sharing must count toward the enrollee’s deductible and out‑of‑pocket maximums. The rule is implemented by adding parallel requirements to the Public Health Service Act, the Internal Revenue Code, and ERISA so it applies across commercial group and individual plans governed by federal law.