To 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.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The bill provides omnibus section amending Public Health Service Act, Internal Revenue Code, ERISA, Social Security Act (Medicare Part B and Part D), ACA, and HSA rules to cap inhaler cost-sharing at 15 dollars per 30-day, exempts cost-sharing requirements for specified inhaler products under Public Health Service Act for group and individual health insurance plans, and exempts cost-sharing requirements for specified inhaler products under Internal Revenue Code group health plans. It relies on price controls, exemptions, appropriations, and compliance mandates. The main policy areas are Healthcare and Finance.
Who Benefits and How
Pharmaceutical companies (inhaler manufacturers) could gain revenue opportunities, Uninsured individuals with asthma and COPD could see lower costs, and Uninsured individuals needing inhalers could see lower costs.
Who Bears the Burden and How
Health insurance issuers (group and individual markets) could face higher costs, Medicare program (federal government) could face higher costs, and IRC-regulated group health plans (employers) could face higher costs.
Key Provisions
- Provides omnibus section amending Public Health Service Act, Internal Revenue Code, ERISA, Social Security Act (Medicare Part B and Part D), ACA, and HSA rules to cap inhaler cost-sharing at 15 dollars per 30-day...
- Exempts cost-sharing requirements for specified inhaler products under Public Health Service Act for group and individual health insurance plans.
- Exempts cost-sharing requirements for specified inhaler products under Internal Revenue Code group health plans.
- Exempts cost-sharing requirements for specified inhaler products under ERISA group health plans and health insurance issuers offering group health insurance coverage.
- Creates federal payment program for specified inhaler products furnished to uninsured individuals by program-registered providers.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
The bill provides omnibus section amending Public Health Service Act, Internal Revenue Code, ERISA, Social Security Act (Medicare Part B and Part D), ACA, and HSA rules to cap inhaler cost-sharing at 15 dollars per 30-day, exempts cost-sharing requirements for specified inhaler products under Public Health Service Act for group and individual health insurance plans, and exempts cost-sharing requirements for specified inhaler products under Internal Revenue Code group health plans.
Key Policy Areas
Healthcare, Finance
Primary Purpose
The bill provides omnibus section amending Public Health Service Act, Internal Revenue Code, ERISA, Social Security Act (Medicare Part B and Part D), ACA, and HSA rules to cap inhaler cost-sharing at 15 dollars per 30-day, exempts cost-sharing requirements for specified inhaler products under Public Health Service Act for group and individual health insurance plans, and exempts cost-sharing requirements for specified inhaler products under Internal Revenue Code group health plans.
Policy Domains
Affordable Inhalers Act - Comprehensive Inhaler Cost-Sharing Caps
Identified Gains
- Pharmaceutical companies (inhaler manufacturers)
- Uninsured individuals with asthma and COPD
- Uninsured individuals needing inhalers
- Patients with asthma and COPD (group and individual plan enrollees)
- Patients with asthma and COPD (all insurance types)
Identified Costs
- Health insurance issuers (group and individual markets)
- Medicare program (federal government)
- IRC-regulated group health plans (employers)
- Health insurance issuers (group market)
- Group health plans
Sponsors
Legislative Progress
IntroducedMr. Mfume (for himself, Mr. Johnson of Georgia, Ms. Norton, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
HSA-eligible individuals with breathing disorders, Medicare Part B beneficiaries using inhalers, Medicare Part D beneficiaries using inhalers
ERISA-regulated group health plans, Employer-sponsored group health plans, Group health plans
Positive-direction: High-deductible health plans (HDHP administrators)
Negative-direction: ERISA-regulated group health plans, Employer-sponsored group health plans, Group health plans, Health insurance issuers (group and individual markets), Health insurance issuers (group market), IRC-regulated group health plans (employers), Medicare Part D prescription drug plans
Pharmaceutical companies (inhaler manufacturers), Pharmacy benefit managers
Positive-direction: Pharmaceutical companies (inhaler manufacturers)
Negative-direction: Pharmacy benefit managers
Federal government, Medicare program (federal government)
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "HHS Secretary"
- → Establishes and administers the uninsured inhaler payment program; determines reimbursement amounts for program-registered providers
- "Group health plans"
- → Must provide inhaler coverage with no deductible and cost-sharing capped at 15 dollars per 30-day supply
- "Health insurance issuers"
- → Must provide inhaler coverage in group and individual markets with cost-sharing caps
- "Program-registered providers"
- → Licensed providers who agree to cap uninsured patient costs at 15 dollars per month in exchange for federal reimbursement
Key Definitions
Terms defined in this bill
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