Affordable Inhalers and Nebulizers Act of 2025
- Bill Number
- S. 2756
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-09-10: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-02-04T12:03:15Z
AI-Generated Summary
Purpose
The Affordable Inhalers and Nebulizers Act of 2025 aims to make prescription inhaler products more affordable for people treating breathing disorders, such as asthma and chronic obstructive pulmonary disease (COPD). It does this by capping out-of-pocket costs for patients across private insurance, Medicare, and for uninsured individuals, while ensuring broad coverage without high deductibles.
Key Provisions
- Private Health Insurance Coverage:
- Applies to group and individual health plans under the Public Health Service Act (PHSA), Internal Revenue Code (IRC), and Employee Retirement Income Security Act (ERISA).
- Plans must cover all "specified inhaler products" without applying any deductible.
- Cost-sharing (like copays or coinsurance) is limited to no more than $15 per 30-day supply.
- Any cost-sharing paid counts toward the plan's overall out-of-pocket maximum and deductible limits.
- "Specified inhaler products" include maintenance, reliever, or rescue inhalation drugs (e.g., aerosols, metered-dose inhalers, dry powder inhalers, solutions, bronchodilators, and corticosteroids) approved for treating asthma or COPD. This also covers related equipment like masks, tubing, spacers, nebulizers, and valve-holding chambers.
- Safe harbor rules allow high-deductible health plans (HDHPs) and catastrophic plans to waive deductibles for these products without losing their status.
- Medicare Coverage:
- Part B (Outpatient Services): Covers 100% of the approved payment amount for specified inhaler products, minus $15 per 30-day supply. No deductible applies.
- Part D (Prescription Drugs): No deductible for these products; cost-sharing is capped at $15 per month's supply. This applies starting in plan year 2026 and extends to low-income subsidy programs, where copays for these products also cannot exceed $15.
- Alternative prescription drug coverage under Medicare must follow the same rules.
- Program for Uninsured Individuals:
- The Department of Health and Human Services (HHS) must create a payment program starting January 1, 2026.
- Licensed providers (e.g., doctors or pharmacies) can register and submit claims to HHS for providing these products to uninsured people.
- HHS pays providers an appropriate amount (subject to available funding), and patients pay no more than $15 per month's supply.
- Uninsured means not covered by federal health programs (like Medicare or Medicaid), private group/individual insurance, or federal employee plans.
- Providers agree not to charge uninsured patients more than $15 if reimbursed by the program.
- Effective Date and Implementation:
- Changes apply to plan years beginning on or after January 1, 2026.
- HHS can implement via guidance or instructions without full rulemaking.
Significant Changes to Existing Law
- Introduces new mandatory coverage requirements for specified inhaler products in private plans, which previously had no uniform caps on costs or deductibles for these items.
- Amends Medicare Parts B and D to eliminate deductibles and impose a $15 cost-sharing cap, building on existing drug coverage but targeting inhalers specifically (similar to recent insulin cost caps but expanded to respiratory drugs).
- Creates a new HHS payment program under the PHSA for uninsured access, which did not exist before; this shifts some costs from patients to federal funding.
- Adds safe harbors to prevent conflicts with tax-advantaged HDHPs and Affordable Care Act catastrophic plans, ensuring compliance without disrupting their benefits.
Potential Impacts
- On Patients: Reduces financial barriers, potentially improving adherence to treatment for asthma and COPD, which affect millions and can lead to emergencies if unmanaged. Uninsured individuals gain subsidized access.
- On Government Agencies: HHS and Centers for Medicare & Medicaid Services (CMS) will need to administer new rules, process claims, and manage funding for the uninsured program, possibly increasing administrative costs.
- On Health Insurers and Employers: Plans must absorb higher upfront coverage costs but may see offsets from fewer hospitalizations; employers sponsoring plans could face premium adjustments.
- On Providers and Pharmacies: Easier reimbursement for uninsured patients, but they must register and limit patient charges.
- Broader Effects: Could lower overall health care spending by preventing severe episodes, though it may raise short-term costs for plans and Medicare. No direct impact on international relations.
Main Stakeholders Affected
- Patients: Primarily those with asthma or COPD (about 25 million Americans), including Medicare beneficiaries, privately insured individuals, and the uninsured.
- Health Insurers and Plans: Group and individual insurers, plus self-insured employer plans under ERISA.
- Government Entities: HHS and CMS for implementation and payments; Congress for funding the uninsured program.
- Providers: Pharmacies, doctors, and other licensed dispensers of inhalers and related equipment.
- Drug Manufacturers: Indirectly affected through ensured coverage, potentially boosting demand for approved products.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens patient protections under federal health laws by mandating coverage, with enforcement through existing mechanisms (e.g., IRS for tax compliance, CMS audits). Defines terms clearly to avoid disputes, referencing "medically accepted indications" from Social Security Act for drug approvals. Relies on appropriations for the uninsured program, which could limit scope if funding is insufficient.
- Constitutional: No major issues; aligns with Congress's authority over interstate commerce and spending for public health, similar to Affordable Care Act provisions.
- Political: Promotes health equity by addressing high inhaler costs (often $200–$600 without insurance), potentially appealing across parties as a targeted affordability measure. Could set precedent for capping costs on other essential drugs, influencing future drug pricing debates.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Sen. Alsobrooks, Angela D. [D-MD]
Cosponsors (2)
Sen. Van Hollen, Chris [D-MD], Sen. Shaheen, Jeanne [D-NH]
Recent Actions
- 2025-09-10: Read twice and referred to the Committee on Finance.
- 2025-09-10: Introduced in Senate
Bill Versions
- Affordable Inhalers and Nebulizers Act of 2025 — issued 2025-09-10 — PDF (14 pages)