Caps the total amount that a covered person is required to pay for a covered prescription inhaler, prescription device, or prescription equipment to twenty-five dollars ($25.00) per thirty (30) day supply.
Summary
H5302 amends Rhode Island’s prescription drug benefits law to limit out-of-pocket costs for covered asthma inhalers and related delivery equipment. For any health plan that covers prescription inhalers, prescription devices, or prescription equipment used to administer inhaled medications, the bill requires the plan to cap the covered person’s cost at no more than $25 for a 30-day supply. It also prohibits applying a deductible to those covered items.
The bill defines “prescription inhaler” broadly to include FDA-approved inhaled medications for treating or preventing respiratory conditions, including metered dose inhalers, dry powder inhalers, and soft mist inhalers. It also covers prescribed devices and equipment such as nebulizers and holding chambers. The bill allows plans to set lower cost-sharing if they choose, and it limits prior authorization to confirming that a diagnosis or medical condition supports medical necessity. The Office of the Health Insurance Commissioner is given enforcement authority and rulemaking power to implement the law and align it with federal requirements. The act would take effect January 1, 2026.
Impact
This bill would add a new section to Rhode Island General Laws chapter 27-20.8, creating a statewide cost-sharing cap for asthma inhalers and related respiratory delivery devices under health coverage plans. It would directly affect insurers and health plans by restricting deductibles and limiting member cost-sharing for these prescription items, while also shaping prior authorization practices and giving the insurance commissioner enforcement authority. Patients who rely on inhalers, nebulizers, and similar equipment would be the primary beneficiaries.
Sentiment
Based on the bill text and available context, the measure appears consumer- and patient-protective, with an emphasis on improving affordability and access to essential respiratory medications. The introduction by multiple representatives suggests broad legislative interest, and there is no recorded committee testimony or vote history in the provided materials indicating opposition or amendment debate. Overall, the bill’s framing suggests a favorable sentiment toward reducing prescription drug costs for people with asthma and other respiratory conditions.
Contention
The main potential points of contention are likely to involve insurer cost-sharing limits, administrative requirements, and prior authorization restrictions. Health plans may view the $25 cap and deductible prohibition as a mandate that could increase plan costs or affect premium pricing, while patient advocates would likely support the measure as a necessary affordability safeguard. Another possible issue is the bill’s interaction with federal insurance requirements, which the legislation addresses by authorizing the commissioner to align implementation with federal law.
Prescriptions for testosterone not allowed to be transmitted or reported within the prescription drug monitoring database and removes from the records all existing information concerning prior testosterone prescriptions.
Prescriptions for testosterone not allowed to be transmitted or reported within the prescription drug monitoring database and removes from the records all existing information concerning prior testosterone prescriptions.
Increases the maximum fill for non-opioid, non-narcotic controlled substances found in schedule II, so that a sixty-day (60) supply may be dispensed at any one time.
Increases the maximum fill for non-opioid, non-narcotic controlled substances found in schedule II, so that a ninety-day (90) supply may be dispensed at any one time.