Sponsors (3)
The bill sharply reduces out-of-pocket costs and improves access to specified inhalers for people with chronic respiratory conditions (including uninsured and Medicare/Medicaid beneficiaries), but shifts costs to plans and taxpayers and may prompt insurer formulary responses and added administrative complexity.
People with asthma or COPD — including Medicare and Medicaid beneficiaries — will pay no deductible and at most $15 per 30-day supply for specified inhalers, lowering out-of-pocket costs and improving medication affordability and adherence.
Any copayment up to $15 counts toward deductibles and out-of-pocket maxima, helping enrollees reach catastrophic protections sooner and reducing their overall financial risk from drug spending.
Uninsured individuals can obtain the specified inhaler products with liability capped at $15 when dispensed by HHS‑program‑registered providers, expanding access for low‑income and uninsured people.
Plans and taxpayers may face higher spending to cover inhalers and related equipment, which could contribute to higher insurance premiums, employer costs, or federal expenditures.
Insurers may respond by narrowing drug formularies or steering patients toward preferred products, limiting patient choice and possibly disrupting continuity of care.
The HHS payment program that caps uninsured liability depends on appropriations and provider participation, so real-world access for uninsured people could be limited if funding or enrollment is insufficient.
Based on analysis of 2 sections of legislative text.
Requires private group and individual plans to cover inhalers, nebulizers, and related equipment with no deductible and max cost-sharing of $15 per 30-day supply, counting toward OOP limits.
Introduced September 10, 2025 by Angela Deneece Alsobrooks · Last progress September 10, 2025
Requires group and individual health insurance plans to cover inhalers, nebulizers, and related administration equipment for asthma and COPD with no deductible and a maximum patient cost-sharing of $15 per 30-day supply. Any cost-sharing still counts toward the enrollee’s deductible and out-of-pocket maximum.