Affordable Inhalers and Nebulizers Act of 2025
The Affordable Inhalers and Nebulizers Act of 2025 aims to significantly reduce what patients pay out of pocket for prescription inhaler products (including devices used to administer them) used to treat asthma and COPD. The bill would establish a uniform $15 cap for cost-sharing per 30-day supply and eliminate deductibles for these products across private insurance (through the Public Health Service Act, Internal Revenue Code, and ERISA), and would apply similar protections in Medicare. It also creates a program to reimburse providers who furnish these inhaler products to uninsured individuals, so patients do not face higher costs. The measure defines “specified inhaler products” to include both the drugs (maintenance, reliever, or rescue inhalers) and the associated administration equipment (spacers, nebulizers, masks, etc.). The changes would begin to take effect for plan years starting in 2026 and include safe harbors to preserve certain plan designs (like high-deductible plans) and adjustments to Medicare costs and coverage. In short, the bill seeks broad, cross-cutting cost-sharing relief for inhaler therapies and related devices, expanding protections to insured private plans, Medicare, and uninsured individuals through a payer/provider program, with a focus on asthma and COPD treatments.
Key Points
- 1Coverage and cost-sharing cap: Requires private group health plans, health insurance issuers, and related coverage to cover all specified inhaler products without a deductible and with cost-sharing not exceeding $15 per 30-day supply; applies across PHSA Part D, IRC, and ERISA plans (with parallel provisions in each respective statute).
- 2Counting toward deductibles and out-of-pocket maximums: Any cost-sharing for specified inhaler products must be counted toward an enrollee’s deductible and out-of-pocket maximum, as if the standard cost-sharing rules applied.
- 3Medicare and Part D/D-2 adjustments: Creates similar $15-per-30-day cap and no-deductible rules for specified inhaler products under Medicare Part B and Part D, including adjustments to payment amounts and deductible rules for these products (with applicable conformity across the Medicare statute sections cited).
- 4Uninsured patient payment program: Establishes a program under Part P to reimburse program-registered providers for specified inhaler products furnished to uninsured individuals, with the provider agreeing not to bill the uninsured patient beyond $15 per 30-day supply if a payment is made under the program.
- 5Definition and scope of specified inhaler products: Defines “specified inhaler product” to include maintenance, reliever, or rescue inhalers (in various formulations) and any equipment used to administer them (e.g., masks, tubing, spacers, nebulizers, valve-holding chambers), with medically accepted indications for asthma or COPD.