Affordable Inhalers and Nebulizers Act of 2025
The Affordable Inhalers and Nebulizers Act of 2025 would drastically reduce out-of-pocket costs for inhaler medicines and related equipment used to treat asthma and COPD. It creates uniform cost-sharing rules across private insurance, Medicare, and ERISA plans, capping patient cost-sharing for specified inhaler products at $15 per 30-day supply and eliminating deductibles for these products. It also requires that any cost-sharing paid by a patient for these inhalers counts toward deductibles and out-of-pocket maximums. In addition, the bill establishes a new federal payment program to provide specified inhaler products to uninsured individuals at no more than $15 per 30-day supply, paid for by the government through the Secretary of Health and Human Services. The reforms would take effect for plan years beginning in 2026 and include safety-net provisions for high-deductible plans and catastrophic coverage, as well as Medicare and Medicaid-related adjustments.
Key Points
- 1New coverage and cost-sharing limits: For private insurance, group plans, and ERISA plans, all specified inhaler products must be covered with no deductible and no more than $15 per 30-day supply in cost-sharing; equipment used to administer the drugs is included.
- 2Definition of specified inhaler product: Includes maintenance, reliever, or rescue inhalers (inhalation aerosols, metered-dose inhalers, dry-powder inhalers, inhalation solutions, bronchodilators, corticosteroids) and related administration devices (masks, tubing, spacers, nebulizers, valve-holding chambers) with medically accepted indications for asthma or COPD.
- 3Medicare and Medicaid adjustments: Medicare Part B and Part D would cap cost-sharing for these products at $15 per 30-day supply, with specific payment mechanisms and deductible changes; similar adjustments apply to applicable Medicare Part D coverage and low-income protections.
- 4Uninsured individuals payment program: Starting January 1, 2026, the Secretary must establish a program where providers submit claims to the government and are paid for specified inhaler products provided to uninsured individuals, with providers agreeing not to bill these individuals more than $15 per 30-day supply.
- 5Implementation and safety provisions: Safe-harbor provisions ensure no deductible counts against high-deductible health plans (HDHPs) and extends safe harbors for catastrophic plans; the changes apply to plan years beginning in 2026, with conforming amendments across multiple health programs.