Sponsors (14)
Introduced September 10, 2025 by Kweisi Mfume · Last progress September 10, 2025
The bill sharply reduces out-of-pocket costs and improves access to inhalers for people with asthma and COPD (including Medicare beneficiaries and the uninsured), but does so at the expense of higher costs for insurers and the federal budget, added administrative burden, and potential weakening of insurers' cost-control tools.
People with asthma or COPD — including Medicare beneficiaries and low-income or uninsured patients — will pay no more than $15 per 30-day supply for covered inhalers, substantially lowering out-of-pocket medication costs.
Amounts patients pay under the $15 cap count toward deductibles and out-of-pocket maximums, helping enrollees reach cost limits sooner and access additional covered care.
Uninsured individuals can receive specified inhalers from program-registered providers without being billed more than $15 per month, improving access to essential maintenance and rescue medications for people without coverage.
Insurers and employers will face higher prescription coverage costs to absorb the $15 cap, which could translate into higher premiums, increased employer costs, or reduced benefits elsewhere.
Federal spending may rise to subsidize uninsured access and to implement Medicare payment adjustments, increasing budgetary pressure and potentially requiring trade-offs in other spending or additional appropriations.
Health plans and administrators will incur compliance and administrative costs to implement the new coverage, counting, and reporting rules, raising plan overhead and administrative burden for payers and providers.
Based on analysis of 2 sections of legislative text.
Requires group and individual health plans to cover inhalers and related equipment for asthma/COPD with no deductible and a $15 cap per 30-day supply, counting toward OOP max.
Requires group and individual health plans to cover inhalation drugs and related delivery equipment used to treat asthma and COPD without applying a deductible and with cost-sharing capped at $15 per 30-day supply; any cost-sharing must count toward the enrollee’s deductible and out-of-pocket maximum. The mandate is added across federal insurance law, the Internal Revenue Code, and ERISA so it applies to group plans, ERISA-governed employer plans, and individual market coverage.