Bill > S0461

This bill caps the total amount that a person with health insurance can be required to pay for prescription asthma inhalers, devices, and equipment at $25 for a 30-day supply. The legislation defines "prescription inhalers" as FDA-approved inhaled medications for respiratory conditions, including different types like metered dose inhalers (pMDI), dry powdered inhalers (DPI), and soft mist inhalers (SMI), but excluding over-the-counter medications. "Prescription devices" and "prescription equipment" refer to supplies used to administer inhaled medications, such as nebulizers and holding chambers. The bill mandates that health plans cannot charge a covered person more than $25 for these items per 30-day supply and prohibits applying deductibles to such coverage. The legislation also specifies that prior authorization can only be used to confirm medical necessity, allows health plans to charge less than the $25 cap if they choose, and grants the office of the health insurance commissioner enforcement powers to ensure compliance. The new regulations will take effect on January 1, 2026, giving health plans time to adjust their policies and systems.

Health and Social Services

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