Affordable Inhalers and Nebulizers Act of 2025
Affordable Inhalers and Nebulizers Act of 2025 would dramatically reduce out-of-pocket costs for prescription inhaler products (including devices like nebulizers, spacers, masks, etc.) used to treat asthma and COPD. The bill requires private insurance plans, group health plans, and health insurance issuers to cover all specified inhaler products with no deductible and no more than $15 per 30-day supply, and it mandates that any cost-sharing for these products count toward deductibles and out-of-pocket maximums. It also extends similar protections to Medicare (Part B and Part D) and creates a new program to cover these products for uninsured individuals starting in 2026. In addition, the bill establishes various safe harbors (e.g., for high-deductible health plans) and makes conforming amendments to the Internal Revenue Code and ERISA to implement these changes.
Key Points
- 1No deductible and a $15 cap per 30-day supply for specified inhaler products in private insurance (PHSA Part D, IRC Sec. 9826, ERISA Sec. 726) and for associated equipment.
- 2Any cost-sharing for specified inhaler products must be counted toward the plan’s deductible and out-of-pocket maximums.
- 3Broad definition of “specified inhaler product” includes maintenance, reliever, and rescue inhalers (various inhaler types) plus administration equipment (masks, tubing, spacers, nebulizers, etc.) with medically accepted indications for asthma or COPD.
- 4Medicare changes: Part B and Part D updates to set cost-sharing at $15 per 30-day supply (with the plan or payer covering the remainder) and to exclude these inhaler products from applying certain deductibles.
- 5Uninsured individuals: creation of a new payment program (Sec. 399V-8) where program-registered providers are paid by the secretary to furnish specified inhaler products, with a $15 per 30-day supply cap and protections to prevent uninsured patients from owing more than $15.
- 6Safe harbors and effective dates: HDHP safe harbor ensures lack of a deductible for specified inhaler products does not disqualify a plan as a high-deductible health plan for plan years beginning in 2026 or later; catastrophic plan safe harbor updated to reference these provisions; most amendments apply to plan years beginning on or after January 1, 2026.