Sponsors (3)
The bill makes inhalers substantially more affordable and accessible for people with asthma/COPD (including many Medicare, Medicaid, and some uninsured patients) by capping cost-sharing and counting payments toward out-of-pocket limits, while increasing public and insurer costs and introducing potential insurer formulary responses and administrative complexity that could limit choice or produce uneven access.
People with asthma or COPD — including Medicare and Medicaid beneficiaries and many insured patients — will face much lower out-of-pocket costs for specified inhalers (no deductible and at most $15 per 30-day supply); Medicare beneficiaries also will not owe the Part B or Part D deductible for these products, reducing financial barriers to needed medication.
Any copayment up to $15 for the specified inhalers counts toward plan deductibles and out-of-pocket maxima, helping enrollees reach catastrophic protections sooner and lowering total annual drug spending for high users.
Uninsured individuals can obtain the specified inhaler products with liability capped at $15 when dispensed by program-registered providers, improving access for people without coverage.
Plans and taxpayers may face higher spending to cover the inhalers and associated equipment, which could lead to higher insurance premiums or increased federal costs.
Insurers may respond by narrowing formularies or steering patients to preferred products, reducing patient choice and possibly limiting access to certain inhaler brands or delivery types.
The HHS payment/dispensing program that enables the uninsured $15 cap depends on appropriations and provider participation, so real-world access for uninsured people could be limited, uneven, or temporary if funding or enrollment is insufficient.
Based on analysis of 2 sections of legislative text.
Requires group and individual health plans to cover specified inhaler drugs and equipment with no deductible and cost-sharing capped at $15 per 30-day supply, counting toward OOP maximums.
Official title: 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 Angela Deneece Alsobrooks · Last progress September 10, 2025
Requires group and individual health plans to cover defined inhaler drugs and related administration equipment for asthma and COPD with no deductible and patient cost-sharing capped at $15 per 30-day supply; any cost-sharing still counts toward a member’s deductible and out-of-pocket maximum. The rule is added both to the Public Health Service Act (insurance market rules) and to the Internal Revenue Code for group health plans, and it specifies covered product types (aerosols, metered-dose and dry-powder inhalers, inhalation solutions, bronchodilators, corticosteroids) and equipment (masks, tubing, spacers, nebulizers, valve-holding chambers).