,,ii  #aaith ,,congress  #ast ,session  
,s4 #bgef  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,september #aj1
 #bjbe,ms4 ,alsobrooks 7for herself and 
,mr4 ,van ,hollen7 introduced the       
following bill2 which was read twice and
 referred to the ,committee on ,finance 
,a ,,bill  ,to amend title ,,xxvii of   
the ,public ,health ,service ,act1 the  
,internal ,revenue ,code of #aihf1 and  
the ,employee ,retirement ,income       
,security ,act of #aigd to reduce       
patient cost-sharing for prescription   
drug inhaler products used to treat     
breathing disorders such as asthma and  
chronic obstructive pulmonary disease1  
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,affordable ,inhalers and ,nebulizers   
,act of #bjbe4  #b4 ,reducing patient   
cost-sharing for prescription drug      
inhaler products used to treat breathing
 disorders such as asthma and chronic   
obstructive pulmonary disease  7a7      
,coverage and cost-,sharing requirements

  7#a7 ,private insurance  7,a7 ,,phsa  
,part ,d of title ,,xxvii of the ,public
 ,health ,service ,act 7#db ,u4,s4,c4   
#cjj;gg-#aaa et seq47 is amended by     
adding at the end the following new     
section3  #bgii;,a-#aa4 ,coverage and   
cost-sharing requirements for specified 
inhaler products  7a7 ,in general ,a    
group health plan1 and a health         
insurance issuer offering group or      
individual health insurance coverage1   
shall provide benefits under such plan  
or coverage 7as applicable7 for all     
specified inhaler products and1 with    
respect to such a product1 may not--    
7#a7 apply any deductible2 or  7#b7     
impose any cost-sharing requirement in  
excess of #ae per #cj-;day supply of    
such product4  7b7 ,counting            
cost-,sharing towards deductible and    
out-of-,pocket maximum ,a group health  
plan1 and a health insurance issuer     
offering group or individual health     
insurance coverage1 shall count any     
cost-sharing requirement described in   

subsection 7a77#b7 incurred by a        
participant1 beneficiary1 or enrollee of
 such plan or coverage with respect to a
 specified inhaler product towards any  
out-of-pocket maximum and any deductible
 that1 but for application of subsection
 7a71 would have applied to such        
participant1 beneficiary1 or enrollee   
with respect to such product4  7c7      
,specified inhaler product defined ,for 
purposes of this section1 the term      
specified inhaler product means any     
maintenance or reliever or rescue       
inhalation drug 7including inhalation   
aerosols1 metered dose inhalers1 dry    
powder inhalers1 inhalation solutions1  
bronchodilators1 and corticosteroids7   
with a medically accepted indication 7as
 defined in section #aibg7k77#f7 of the 
,social ,security ,act7 for the         
treatment for lung diseases such as     
asthma and chronic obstructive pulmonary
 disease4 ,such term includes any       
equipment used in the administration of 
such drug 7such as masks and tubing1    

spacers1 nebulizers1 and valve-holding  
chambers74  4  7,b7 ,,irc  7i7 ,in      
general ,subchapter ,b of chapter #ajj  
of the ,internal ,revenue ,code of #aihf
 is amended by adding at the end the    
following new section3  #ihbf4 ,coverage
 and cost-sharing requirements for      
specified inhaler products  7a7 ,in     
general ,a group health plan shall      
provide benefits under such plan for all
 specified inhaler products and1 with   
respect to such a product1 may not--    
7#a7 apply any deductible2 or  7#b7     
impose any cost-sharing requirement in  
excess of #ae per #cj-;day supply of    
such product4  7b7 ,counting            
cost-,sharing towards deductible and    
out-of-,pocket maximum ,a group health  
plan shall count any cost-sharing       
requirement described in subsection     
7a77#b7 incurred by a participant or    
beneficiary of such plan with respect to
 a specified inhaler product towards any
 out-of-pocket maximum and any          
deductible that1 but for application of 

subsection 7a71 would have applied to   
such participant or beneficiary with    
respect to such product4  7c7 ,specified
 inhaler product defined ,for purposes  
of this section1 the term specified     
inhaler product means any maintenance or
 reliever or rescue inhalation drug     
7including inhalation aerosols1 metered 
dose inhalers1 dry powder inhalers1     
inhalation solutions1 bronchodialators1 
and corticosteroids7 with a medically   
accepted indication 7as defined in      
section #aibg7k77#f7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#acifd-h7k77#f777 for the treatment of  
asthma or of chronic obstructive        
pulmonary disease4 ,such term includes  
any equipment used in the administration
 of such drug 7such as masks and tubing1
 spacers1 nebulizers1 and valve-holding 
chambers74  4  7ii7 ,clerical amendment 
,the table of sections for subchapter ,b
 of chapter #ajj of the ,internal       
,revenue ,code of #aihf is amended by   
adding at the end the following new     

item3  ,sec4 #ihbf4 ,coverage and       
cost-sharing requirements for specified 
inhaler products4  4  7,c7 ,,erisa  7i7 
,in general ,subpart ,b of part #g of   
subtitle ,b of title ,i of the ,employee
 ,retirement ,income ,security ,act of  
#aigd is amended by adding at the end   
the following new section3  #gbf4       
,coverage and cost-sharing requirements 
for specified inhaler products  7a7 ,in 
general ,a group health plan1 and a     
health insurance issuer offering group  
health insurance coverage1 shall provide
 benefits under such plan or coverage   
7as applicable7 for all specified       
inhaler products and1 with respect to   
such a product1 may not-- 7#a7 apply any
 deductible2 or  7#b7 impose any        
cost-sharing requirement in excess of   
#ae per #cj-;day supply of such product4
  7b7 ,counting cost-,sharing towards   
deductible and out-of-,pocket maximum ,a
 group health plan1 and a health        
insurance issuer offering group health  
insurance coverage1 shall count any     

cost-sharing requirement described in   
subsection 7a77#b7 incurred by a        
participant or beneficiary of such plan 
with respect to a specified inhaler     
product towards any out-of-pocket       
maximum and any deductible that1 but for
 application of subsection 7a71 would   
have applied to such participant or     
beneficiary with respect to such        
product4  7c7 ,specified inhaler product
 defined ,for purposes of this section1 
the term specified inhaler product means
 any maintenance or reliever or rescue  
inhalation drug 7including inhalation   
aerosols1 metered dose inhalers1 dry    
powder inhalers1 inhalation solutions1  
bronchodialators1 and corticosteroids7  
with a medically accepted indication 7as
 defined in section #aibg7k77#f7 of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acifd-h7k77#f777 for the treatment of  
asthma or of chronic obstructive        
pulmonary disease4 ,such term includes  
any equipment used in the administration
 of such drug 7such as masks and tubing1

 spacers1 nebulizers1 and valve-holding 
chambers74  4  7ii7 ,clerical amendment 
,the table of contents in section #a of 
the ,employee ,retirement ,income       
,security ,act of #aigd 7#bi ,u4,s4,c4  
#ajja note7 is amended by inserting     
after the item relating to section #gbe 
the following new item3  ,sec4 #gbf4    
,coverage and cost-sharing requirements 
for specified inhaler products4  4  7,d7
 ,conforming amendments  7i7 ,,hdhp safe
 harbor ,section #bbc7;c77#b7 of the    
,internal ,revenue ,code of #aihf is    
amended by adding at the end the        
following new subparagraph3  7,i7 ,safe 
harbor for absence of deductible for    
specified inhaler products ,for plan    
years beginning on or after ,january #a1
 #bjbf1 a plan shall not fail to be     
treated as a high deductible health plan
 by reason of failing to have a         
deductible for specified inhaler        
products 7as defined in section         
#bgii;,a-#aa of the ,public ,health     
,service ,act74  4  7ii7 ,catastrophic  

plan safe harbor ,section               
#acjb7;e77#a77;,b77i7 of the ,patient   
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #ahjbb7;e77#a77;,b77i77  
is amended by inserting or #bgii;,a-#aa 
of the ,public ,health ,service ,act    
after section #bgac4  7,e7 ,effective   
date ,the amendments made by this       
paragraph shall apply to plan years     
beginning on or after ,january #a1      
#bjbf4  7#b7 ,medicare  7,a7 ,part ,b   
,section #ahcc of the ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7 is amended--
 7i7 in subsection 7a77#a77,s7-- 7,i7 in
 clause 7i71 by inserting or 7iii7 after
 clause 7ii72 and  7,,ii7 by adding at  
the end the following new clause3 and   
7iii7 with respect to a specified       
inhaler product 7as defined in section  
#bgii;,a-#aa of the ,public ,health     
,service ,act7 furnished on or after    
,january #a1 #bjbf1 the amounts paid    
shall be #ajj percent of the lesser of  
the actual charge or the payment amount 
established in section #ahdb7o7 7or1 if 

applicable1 under section #ahdg1        
#ahdg;,a1 or #ahdg;,b71 less1 per       
#cj-;day supply of such product1 #ae12  
and  7ii7 in subsection 7b71 in the     
first sentence-- 7,i7 in paragraph      
7#ab71 by striking 1 and2 and  7,,ii7 by
 striking 44 and inserting 1 and 7#ad7  
such deductible shall not apply with    
respect to a specified inhaler product  
7as defined in section #bgii;,a-#aa of  
the ,public ,health ,service ,act7      
furnished on or after ,january #a1      
#bjbf44  7,b7 ,part ,d  7i7 ,in general 
,section #ahfj;,d-#b7;b7 of the ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#ajb7;b77 is amended-- 7,i7 in   
paragraph 7#a77;,a71 by striking        
paragraphs 7#h7 and 7#i7 and inserting  
paragraphs 7#h71 7#i71 and 7#aj72       
7,,ii7 in paragraph 7#b77;,a71 by       
striking paragraphs 7#h7 and 7#i7 and   
inserting paragraphs 7#h71 7#i71 and    
7#aj72  7,,iii7 in paragraph            
7#d77;,a77i71 by striking paragraphs    
7#h7 and 7#i7 and inserting paragraphs  

7#h71 7#i71 and 7#aj72 and  7,,iv7 by   
adding at the end the following new     
paragraph3  7#aj7 ,treatment of         
cost-sharing for specified inhaler      
products  7,a7 ,no application of       
deductible ,for plan year #bjbf and     
subsequent plan years1 the deductible   
under paragraph 7#a7 shall not apply    
with respect to any specified inhaler   
product4  7,b7  ,application of         
cost-sharing  ,for plan year #bjbf and  
subsequent plan years1 the coverage     
provides benefits for any specified     
inhaler product with cost-sharing for a 
month's supply that does not exceed #ae4
  7,c7  ,definition  ,for purposes of   
this paragraph1 the term specified      
inhaler product has the meaning given   
such term in section #bgii;,a-#aa of the
 ,public ,health ,service ,act4  4  7ii7
 ,conforming amendment for alternative  
prescription drug coverage ,section     
#ahfj;,d-#b7;c7 of the ,social ,security
 ,act 7#db ,u4,s4,c4 #aciew-#ajb7;c77 is
 amended by adding at the end the       

following new paragraph3  7#g7          
,treatment of cost-sharing for specified
 insulin products ,the coverage in      
provided in accordance with subsection  
7b77#aj74  4  7iii7  ,conforming        
amendments to cost-sharing for          
low-income individuals  ,section        
#ahfj;,d-#ad7;a77#a7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#aciew-#aad7;a77#a77 is amended--  7,i7 
in subparagraph 7,d77iii71 by adding at 
the end the following new sentence3 ,for
 plan year #bjbf and subsequent plan    
years1 the copayment amount applicable  
under the preceding sentence to a       
month's supply of a specified inhaler   
product 7as defined in section          
#ahfj;,d-#b7;b77#aj77 dispensed to the  
individual may not exceed #ae42 and     
7,,ii7 in subparagraph 7,e71 by         
inserting or under section              
#ahfj;,d-#b7;b77#aj7 in the case of a   
specified inhaler product 7as defined in
 such section7 after 7as defined in     
subparagraph 7,c7 of such section74  7b7

 ,payment program for uninsured         
individuals ,part ,p of title ,,iii of  
the ,public ,health ,service ,act 7#db  
,u4,s4,c4 #bhj;g et seq47 is amended by 
adding at the end the following new     
section3  #cii,v-#h4 ,specified inhaler 
product payment program  7a7 ,in general
 ,beginning ,january #a1 #bjbf1 the     
,secretary shall establish a program    
under which-- 7#a7 program-registered   
providers submit claims to the          
,secretary with respect to the          
furnishing of specified inhaler products
 7as defined in subsection 7b77 to      
uninsured individuals2 and  7#b7 the    
,secretary1 subject to the availability 
of appropriations1 pays each such       
provider for such products in an amount 
determined appropriate by the           
,secretary4  7b7 ,definitions ,in this  
section3 7#a7 ,program-registered       
provider ,the term program-registered   
provider means a health care provider   
that-- 7,a7 is licensed or otherwise    
authorized to administer or dispense    

specified inhaler products in the ,state
 in which such provider so administers  
or dispenses such products under the    
program established under this section2 
and  7,b7 enters into an agreement with 
the ,secretary under which the provider 
agrees not to hold an uninsured         
individual liable for the cost of any   
such product administered or dispensed  
to such individual in an amount         
exceeding #ae for a month's supply of   
such product if a payment is made under 
subsection 7a77#b7 with respect to such 
product so administered or dispensed4   
7#b7 ,specified inhaler product ,the    
term specified inhaler product has the  
meaning given such term in section      
#bgii;,a-#aa4  7#c7 ,uninsured          
individual ,the term uninsured          
individual means1 with respect to an    
individual furnished a specified inhaler
 product1 an individual who is not      
enrolled in-- 7,a7 a ,federal health    
care program 7as defined in section     
#aabh;,b7f7 of the ,social ,security    

,act72  7,b7 a group health plan or     
health insurance coverage offered by a  
health insurance issuer in the group or 
individual market 7as such terms are    
defined in section #bgia72 or  7,c7 a   
health plan offered under chapter #hi of
 title #e1 ,united ,states ,code4  4    
7c7 ,implementation ,the ,secretary of  
,health and ,human ,services may        
implement the amendments made by this   
section by program instruction1         
subregulatory guidance1 or otherwise4