Sponsors (14)
The bill makes inhalers significantly 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 government, which could raise premiums, complicate plan design, and create reimbursement tensions.
People with asthma or COPD — including low-income and uninsured patients — would pay no more than $15 per 30‑day supply for covered inhalers and uninsured patients could obtain inhalers through an HHS payment program with the same cap, improving affordability and access.
Medicare beneficiaries would not owe Part B or Part D deductibles for specified inhaler products and would face reduced cost sharing for those inhalers, lowering out‑of‑pocket spending for seniors and people on Medicare.
Permitting the capped cost sharing to count toward enrollees' out‑of‑pocket maxima protects people with high drug needs from reaching higher spending thresholds faster, providing broader financial protection.
Insurers and employers may face higher plan costs from the inhaler caps and payment rules, which could lead to higher premiums, increased taxpayer/backstop spending, or reduced benefits elsewhere over time.
Plans, issuers, employers, and HHS will need to make administrative and system changes (including to preserve HDHP safe harbor), increasing compliance complexity and administrative costs ahead of the Jan 1, 2026 effective date.
Manufacturers, pharmacies, providers, and hospitals could face lower reimbursements or payment disputes because Medicare payment rules tie reimbursements to the lesser of actual charge or established amounts, potentially squeezing provider revenues.
Based on analysis of 2 sections of legislative text.
Requires group and individual health plans to cover specified inhalers and related equipment with no deductible and cost‑sharing capped at $15 per 30‑day supply, counting toward OOP limits.
Introduced September 10, 2025 by Kweisi Mfume · Last progress September 10, 2025
Requires group and individual health insurance plans to cover a broad set of inhaler drugs and related administration equipment with no deductible and with cost‑sharing capped at $15 per 30‑day supply. Any permitted copayment or coinsurance must count toward the enrollee’s deductible and out‑of‑pocket maximum. The changes are implemented by adding parallel requirements to the Public Health Service Act, the Internal Revenue Code, and ERISA-related plan rules.