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Why are Asthma Inhalers So Expensive?

January 6, 2020

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Like many routine prescription drugs and medications in the United States, the cost of asthma inhalers has skyrocketed in recent years. In just under a decade, the price of some of the most prescribed asthma inhalers has increased by as much as 50% or more, far outpacing the average rate of inflation.

In addition to the cost of asthma inhalers, the Centers for Disease Control and Prevention (CDC) estimate that asthma, one of the most common chronic illnesses in the United States, accounts for over $80 billion in additional yearly expenses like hospital visits, missed work and school, and serious health complications for people that avoid filling their prescriptions and taking the medication they need when asthma inhalers are too expensive.

Why Asthma Inhalers Are So Expensive in the United States

Unlike medications that are taken in pill or injection form, asthma inhalers consist of several moving parts that affect everything from patent rights to the manufacturing process — and ultimately how much they end up costing American consumers.

In addition to the drug, an asthma inhaler also needs a propellant agent to deliver the dose through the airway and into the lungs, and the outer canister. According to the American Academy of Allergy Asthma and Immunology (AAAAI), there are three main types of asthma inhalers on the market:

  • Metered dose inhalers (MDI)
  • Nebulizers
  • Dry powder inhalers (DPI)

Metered dose asthma inhalers use a chemical propellant agent to "pump" the medication directly into the lungs. Nebulizers work a little differently than MDI inhalers and deliver the medication in mist form through pressurized oxygen in a tube or mask. Dry powder inhalers don't use a chemical propellant and the medication is delivered to the lungs by taking a deep breath and inhaling the drug on your own.

The Surprising Connection Between Climate Change, Government Regulation, Patent Protections, and Your Asthma Medication

At the end of 2008, the U.S. Food and Drug Administration (FDA) phased out the manufacture and sale of asthma inhalers that contained CFC propellants (chlorofluorocarbons) in the United States over growing concerns over the effect that the industrial use of chlorofluorocarbons, which are primarily used in refrigeration and air conditioning units, was having on the integrity of the ozone layer.

CFC inhalers were replaced with HFA (hydrofluoroalkanes) asthma inhalers. As U.S. pharmaceutical companies and drug manufacturers made the transition from CFC to HFA based asthma inhalers, the costs of the new propellant increased and made it more difficult for consumers to save money on generic versions of common asthma inhalers like Albuterol.

The transition to HFA inhalers led to a number of new patents for what was essentially the same drug, making it increasingly more expensive. The CFC based inhalers were essentially a generic version of the drug for American consumers, keeping the costs of the inhalers in the U.S. fairly comparable to Canadian prices.

After the 2008 ban, however, prices continued to rise steadily in the United States compared to the cost of HFA based asthma inhalers in Canada. According to data compiled by Reuters, the CFC inhaler ban in the United States resulted in higher prices and somewhat of a dip in inhaler use.

Assorted blister packs

Generic vs. Brand Name Asthma Inhalers

Generic drugs use similar ingredients and are subject to similar safety and packaging standards as their more expensive brand name versions. As the patent on a brand name drug or medication expires, it opens up the market for generic versions of the same drug which can then lower costs for consumers.

However, it can take years for the patent protection on a particular drug to expire. According to the FDA, the general term of a new patent in the U.S. is 20 years. There are a number of factors that can affect the lifespan of a patent, and drugs and medications are also subject to "exclusivity" agreements which vary depending on the drug type and category and can range from 180 days to seven years.

The patent process in the U.S. is notoriously complex, and by changing a single ingredient or component of a medication (like the propellant in the case of CFA asthma inhalers), drug manufacturers can essentially rebrand and file new patents on what's essentially the same medication. This process makes drugs more expensive, and delays the availability of more affordable generic versions of the drug for years or even decades.

The Hidden Costs of Expensive Asthma Inhalers

In addition to the direct health risks, unaffordable asthma medication has a trickle effect on everything from quality of life for patients and their families, to the economy and surrounding communities due to lost productivity and secondary healthcare costs.

According to data compiled by the U.S. National Library of Medicine, National Institutes of Health, asthma related school absenteeism for example was more likely among children with poorly managed or untreated asthma. The children who missed school due to asthma symptoms or flare ups were also found to have higher rates of emergency room and urgent care visits. Affordability was found to be one of the main factors in undertreated asthma along with environmental triggers like mold.

With approximately one in 12 children in the U.S. suffering from some form of asthma, absentee rates account for over ten million missed school days per year. Predictably, asthma related school absenteeism has also been associated with lower academic performance.

Secondary Health Risks of Untreated or Under-treated Asthma

In addition to the primary symptoms of the condition, asthma sufferers also have to deal with secondary health and quality of life problems that can also lead to serious health risks and complications — and higher medical bills.

In the United States in particular, where obesity is already a national health crisis that accounts for billions of dollars in healthcare costs each year, children and adults with asthma are especially vulnerable to weight-related health issues.

Other potential health side effects of inadequate physical activity and asthma include:

  • Greater risk of diabetes
  • High blood pressure
  • Sleep problems
  • Greater risk for depression
  • Developmental issues in children

For profit motivated drug manufacturers and people who aren't affected by asthma, expensive asthma inhalers may seem like nothing more than business as usual. But for people living with asthma, not being able to afford an inhaler can have a snowball effect on their individual health, families, employers, and communities with very serious consequences.

As the data has shown, expensive and unaffordable asthma inhalers can result in billions of dollars in extra healthcare costs and lost productivity to the economy.

According to research from the American Thoracic Society, the average yearly per person costs of asthma related healthcare in the United States over the past decade is over $3,000, more than half of which is for prescription medication and asthma inhalers ($1,830).

Additional cost estimates include:

  • $640 for annual office visits
  • $529 for hospitalizations
  • $179 for outpatient hospital visits
  • $105 for emergency room care

The researchers pointed out that the cost estimates from their studies didn't account for untreated asthma and the related expenses, so the total costs are likely much higher than the estimated $80 billion yearly total provided by the CDC.

Long-term Health Risks of Untreated or Poorly Treated Asthma

In addition to the general quality of life and secondary health problems associated with untreated and poorly managed asthma, not being able to afford asthma medication can lead to long term and permanent lung and bronchial damage.

According to the American Lung Association, airway remodeling is a serious condition that results from poorly managed or untreated asthma. Over time, untreated asthma related inflammation can lead to scarring and thickening of the lining of the airway, making it harder to breathe and making asthma medication less effective.

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Why Asthma Inhalers are Cheaper in Canada and Elsewhere

As healthcare costs and prescription drug prices continue to climb beyond the reach of millions of Americans (even with health insurance coverage), more and more people look to Canada and other countries for affordable access to essential medications. While American citizens have been crossing the border into Canada for years to buy more affordable prescription drugs, Canadian pharmacists have noticed a "quiet resurgence" of the practice in recent years according to the CBC.

In Canada (and many other countries), the government regulates the costs of patented medications and sets price limits to keep drugs affordable. So unlike in the United States, where prices are set by the drug companies and can vary wildly depending on patent terms and profit markups, Canadian prescriptions remain reliably more affordable because there are limits to how much the drug companies are allowed to charge.

Canada has stringent safety standards and drug approval protocols for prescription medications like asthma inhalers. For American consumers looking to find cheaper versions of asthma inhalers in Canada or other countries, like the Flovent HFA inhaler, Advair, and generic fluticasone, knowing what to look for in a safe and reputable online Canadian pharmacy and international drugstore is the first place to start.

American consumers end up paying as much as ten times or more as their Canadian counterparts for the same medication due to a lack of price controls and regulation in the United States. Not only are American drug companies allowed to set unlimited prices for patented drugs, making life saving medications like asthma inhalers unaffordable for millions of patients, but they add another layer to the problem by also trying to restrict access to cheaper generic versions of the drugs.

What a Flovent HFA and Advair Asthma Inhaler Costs in Canada

In the United States, a Flovent HFA asthma inhaler currently costs over $200 for 10.6 grams, with no generic alternative currently available. Patents are issued at various stages of the development cycle of a drug and for different components, like the propellant in the case of asthma inhalers, all with different expiration dates. Therefore it can take years for an affordable, generic alternative of the same medication to become available in the United States.

In Canada, a Flovent HFA asthma inhaler costs less than $50. So Americans are paying more than quadruple the price for the same medication.

Advair, another common asthma medication, can range from $300 to $600 — per inhaler — for uninsured patients in the United States. While a generic version was finally approved for American consumers after years of setbacks and delays due to patent disputes, American prices still remain prohibitively expensive for many asthma patients, with or without insurance.

By comparison, similar dosage of Advair Diskus and generic fluticasone inhalers range from $50 to $70 in Canada.

What Expensive Asthma Inhalers Really Cost

The total costs of unaffordable asthma medication and the additional expenses that go along with it can be hard to predict, and vary from person to person and family to family. The numbers presented by the CDC are only estimates and don't account for the fact that many families have more than one child or family member suffering from asthma.

Additionally, the CDC estimates that four out of ten American adults suffer from more than one chronic illness, making healthcare and medication costs even more unaffordable and out of reach for many vulnerable people. According to the Asthma and Allergy Foundation of America, approximately ten Americans die from asthma complications every day, most of which are avoidable with proper management and access to necessary treatment like affordable medication.

If the average price difference between a Flovent HFA inhaler between the United States and Canada is $150 per inhaler, with the average inhaler lasting 60 days depending on the prescribed dosage, that's a savings of $900 for a year's supply for one person. If your doctor recommends a higher dosage or there are multiple asthma sufferers in the family with the same prescription, you're looking at thousands of dollars for the inhaler alone.

Navigating prescription drug costs can be stressful and overwhelming. At our goal is to help you save money on your prescription medications. Our customer service team is available to answer all of your questions and to give you peace of mind throughout the entire process.

For more information, you can call us toll free at 1-866-539-5330 or contact us online.

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