H 7948Health Insurance

Insurance - Prescription Drug Benefits

This bill limits the cost of prescription asthma inhalers and supplies to $25 per month for insured patients.

Held for study

Population
Affected

Introduced Feb 27, 2026Committee House Health & Human Services

Plain-English Summary

This legislation mandates that health insurance plans in Rhode Island cap the out-of-pocket costs for prescription asthma inhalers and related equipment. Specifically, it limits the cost to a covered individual to no more than $25 for a 30-day supply. Furthermore, these items are exempt from insurance deductibles. The bill prevents insurance companies from using prior authorization requirements except to confirm a medical diagnosis. It empowers the Office of the Health Insurance Commissioner to enforce these rules and create necessary regulations. The law is scheduled to take effect on January 1, 2027.

For younger readers

Some people have asthma, which makes it hard to breathe. They need special medicine called inhalers to help them. Sometimes, this medicine costs a lot of money. This new rule says that health insurance companies cannot make people pay more than $25 for a one-month supply of this medicine or the machines used to take it. It also says families don't have to pay a large amount of money first before the insurance helps pay. This helps make sure people can afford the medicine they need to breathe and stay healthy.

Who & Where It Applies

Impacted groups

People with asthmaHealth insurance companiesParents of children with asthmaPharmacistsRespiratory therapists

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Significantly reduces financial barriers for individuals with respiratory conditions, ensuring that low-income families can afford life-saving medication without sacrificing other necessities.
Protects vulnerable populations and communities of color, who statistically suffer from higher rates of asthma due to environmental injustices and systemic inequality.
Checks corporate power by preventing insurance companies from imposing high deductibles or burdensome prior authorization hurdles on essential medical equipment.
Does not apply to uninsured residents, leaving the most marginalized populations without protection against high pharmaceutical costs.
Sets a flat fee of $25 which, while an improvement, may still be a financial burden for those living in extreme poverty compared to a fully subsidized model.
Addresses the symptom of high out-of-pocket costs but fails to tackle the root cause of price gouging by pharmaceutical manufacturers who set the initial prices.

For Conservatives

Promotes a healthier workforce by ensuring employees with asthma can manage their condition, potentially reducing absenteeism and increasing economic productivity.
May reduce the burden on emergency services and taxpayer-funded emergency care by preventing severe asthma attacks through affordable maintenance medication.
Provides clear, specific guidelines for insurance contracts, reducing ambiguity in coverage requirements for policyholders.
Represents government interference in the free market by dictating price controls and contract terms to private businesses.
Likely to result in insurance companies raising premiums for all customers to offset the losses incurred by the mandatory price caps on inhalers.
Expands the regulatory authority and bureaucracy of the Office of the Health Insurance Commissioner, increasing government oversight of the private sector.

Votes

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Full Bill Text

Changes to existing Rhode Island law · 24 additions

SECTION 1. Chapter 27-20.8 of the General Laws entitled "Prescription Drug Benefits" is hereby amended by adding thereto the following section: 27-20.8-5. Co-pay cap for prescription asthma inhalers, devices, and equipment.

(a) As used in this section, unless the context otherwise requires, "prescription inhaler” means a prescribed inhaled medication approved by the FDA for the treatment or prevention of a respiratory condition, and includes, but is not limited to, pressurized metered dose inhalers (pMDI), dry powdered inhalers (DPI), and soft mist inhalers (SMI). "Prescription inhaler" does not include inhaled medications available over-the-counter without a prescription.

(b) As used in this section, unless the context otherwise requires, "prescription devices” and “prescription equipment” means prescribed supplies used to administer inhaled medications, including, but not limited to, nebulizers and holding chambers.

(c) A health plan that provides coverage for prescription inhalers and prescription devices or prescription equipment used to administer prescribed inhaled medications, pursuant to the terms of a health coverage plan the health plan offers, shall cap the total amount that a covered person is required to pay for a covered prescription inhaler, prescription device or prescription equipment used to administer such medications, at an amount not to exceed twenty-five dollars ($25.00), per thirty (30) day supply. Coverage for prescription inhalers, prescription devices or prescription equipment used to administer such medications, shall not be subject to any deductible.

(d) Nothing in this section prevents a health plan from reducing a covered person's cost sharing to an amount less than the amount specified in subsection (c) of this section.

(e) Prior authorization policies shall only be used to confirm the presence of diagnoses or other medical conditions, which demonstrates that an item or service is medically necessary.

(f) The office of the health insurance commissioner may use any of its enforcement powers to obtain a health plan's compliance with this section.

(g) The office of the health insurance commissioner may promulgate rules and regulations as necessary to implement and administer this section and to align with federal requirements.

SECTION 2. This act shall take effect on January 1, 2027.