Asthma meds have turn into shockingly unaffordable − but relief could also be on the way

The price of asthma medication has soared within the U.S. over the past decade and a half.

The jump – in some cases from around somewhat over US$10 to almost $100 for an inhaler – has meant that patients in need of asthma-related products often struggle to purchase them. Others simply can’t afford them.

To make matters worse, asthma disproportionately affects lower-income patients. Black, Hispanic and Indigenous communities have the highest asthma rates. They also shoulder the heaviest burden of asthma-related deaths and hospitalizations. Climate change will likely worsen asthma rates and, consequently, these disparities.

I’m a health law professor at Villanova University, where I study whether patients can get the medicines they need. And I’ve been watching this affordability crisis closely.

In some ways, it shows what happens when law and policy decisions aren’t aligned with public health needs. The excellent news, nonetheless, is that there finally appears to be some political will to rein in the worth of asthma meds.

Why inhaler prices are skyrocketing

In 2008, the U.S. Food and Drug Administration banned inhalers that use chlorofluorocarbons, or CFCs – which were once widely used as propellants – because they’ll damage the ozone layer. The FDA was following a timeline set by an environmental treaty, the Montreal Protocolwhich the U.S. ratified within the late Nineteen Eighties.

From 2009 onward, CFC inhalers were phased out and replaced with hydrofluoroalkane, or HFA, ones, that are more environmentally friendly. They’re also quite a bit pricier. For patients with insurance, the common out-of-pocket cost of an inhaler rose from $13.60 per prescription in 2004 to $25 immediately after the 2008 ban, a 2015 study found.

Today, the average retail price of an albuterol inhaler is $98. Unlike CFC inhalers, which have generic versionsHFA inhalers are covered by patents. While the drug itself hasn’t modified, the switch to a special device allowed firms to extend their prices.

In 2020, the FDA finally approved the first generic version of an albuterol inhaler. But generic competition still isn’t robust enough to lower prices meaningfully.

Patients with good insurance may pay little or no and even nothing. But uninsured patients face steep market prices, and as of 2023, there have been over 25 million uninsured Americans. Even insured patients could have trouble affording their asthma meds, the CDC has found.

The same asthma medication for which U.S. patients pay top dollar is offered elsewhere at less expensive prices. Consider the next case for inhalers. The pharmaceutical company Teva sells QVAR RediHalera corticosteroid inhaler, for $286 within the U.S.

In Germany, Teva sells that very same inhaler for $9.

Seeking meds from Mexico and Canada

Some U.S. patients have traveled abroad to acquire cheaper asthma medication. After the 2008 ban on CFCs, it became common for patients to visit border towns in Mexico to buy albuterol inhalers. They were sold for as little as $3 to $5.

A study of inhalers available to U.S. patients in Nogales, Mexico – about an hour south of Tucson, Arizona – found that Mexican products were generally comparable to U.S. inhalers. But researchers found some differences in performance, suggesting that American patients who use them could possibly be getting a rather different dose than their usual.

There have also been reports of Americans turning to Canadian pharmacies to buy asthma inhalers at less expensive prices. In one case, a U.S. pharmacy would have charged $857 for a three-month supply. A patient obtained it for $134 from a pharmacy in Canada.

One potential fix: Importing cheaper meds

U.S. law has long prohibited personal importation of pharmaceutical drugs. However, a recent development could pave the way in which for states to import cheaper asthma drugs.

In January 2024, the FDA authorized the importation of certain pharmaceuticals from Canada for the primary time. For nowthis authorization is proscribed to Florida, and it covers only drugs for HIV/AIDS, prostate cancer and certain mental health conditions.

Should it prove successful, this system could function a blueprint for other states.

Another possible solution: Price-capping

Policymakers could also try borrowing a page from the insulin playbook. Insulin prices climbed for nearly 20 years before Congress acted, capping the price of insulin for Medicare patients. The 2022 Inflation Reduction Act established an out-of-pocket ceiling of $35 per thirty days for prescription-covered insulin products.

If this cover had been in effect two years earlier, it might have saved 1.5 million Medicare patients about $500 annually, a recent study estimated. It also would have saved Medicare $761 million.

The same approach could possibly be taken for asthma meds.

Congress could create an asthma-specific rule just like the insulin case. Or it could place provisions for asthma-med prices right into a larger piece of laws.

While this approach depends upon the political environment, there are signs the federal government is becoming more willing to act. In January 2024, the U.S. Department of Health and Human Services hosted a gathering to debate the issue with manufacturers and other stakeholders.

It’s a start. And – along with other measures – it brings some hope that asthma meds might soon turn into cheaper to those in need.