S 2876Health Insurance

Insurance - Prescription Drug Benefits

This bill caps the cost of prescription asthma inhalers at $25 per month for insured individuals.

Introduced34 Yea0 Nay4 Not voting

Population
Affected

Introduced Mar 4, 2026Committee Senate 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 co-pay to no more than $25 for a 30-day supply. Furthermore, the bill prohibits these items from being subject to a deductible. The bill also restricts insurance companies from using prior authorization processes for any purpose other than confirming a medical diagnosis. The Office of the Health Insurance Commissioner is authorized to enforce these requirements.

For younger readers

Some people have asthma, which makes it hard to breathe. They need special medicine called inhalers or machines to help them get air into their lungs. Sometimes, these medicines cost a lot of money. This new rule says that insurance companies cannot make people pay more than $25 a month for these breathing medicines and the tools needed to use them. This helps make sure that families can afford the medicine they need to stay healthy without spending too much money.

Who & Where It Applies

Impacted groups

Asthma patientsHealth insurance companiesPharmacistsParents of children with asthmaRespiratory therapists

Impacted communities

All

Constitutional & Fiscal Check

None Likely

Estimated cost

None

Estimated revenue

None

Bill Analysis

Both viewpoints

For Progressives

Ensures that essential, life-saving medication is affordable and accessible to those with chronic respiratory conditions, preventing financial hardship for vulnerable populations.
Prevents insurance corporations from using high deductibles as a barrier to care, ensuring that coverage actually translates to usable healthcare services.
Restricts the ability of insurance companies to use bureaucratic prior authorization tactics to delay or deny necessary medical treatment.
Does not provide relief for individuals who are uninsured, leaving the most marginalized populations without protection against high drug costs.
A $25 monthly fee may still be cost-prohibitive for extremely low-income families or those requiring multiple different prescriptions.
Private insurance companies may attempt to recoup lost revenue by raising premiums, which could indirectly impact the collective cost of healthcare.

For Conservatives

Ensures a healthier workforce by making asthma management affordable, potentially reducing sick days and increasing productivity for businesses.
Streamlines the interaction between doctors and insurers by limiting prior authorization hurdles, reducing administrative waste.
Addresses a specific market failure without raising taxes or creating a new government funding program.
Interferes directly with the free market by imposing government price controls on private business contracts between insurers and customers.
Will likely result in cost-shifting where insurance companies raise premiums for all policyholders to subsidize the capped costs of specific users.
Expands the regulatory power of the state government over the healthcare industry, reducing corporate autonomy.

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.