Why Are Asthma Medications So Expensive

The Generics Are Coming

How do drug prices go down? Until the government puts some reins on this drug pricing nonsense, all we have to push down drug prices is competitive pricing through generic competition. It is the lack of competitive pricing the introduction of fancier, non-CFC inhalers that got us here in the first place.

The good news is, the FDA is actively approving generic inhalers. In 2019, three inhalers got their cheaper counterparts: Advair Diskus, Ventolin HFA, and Proair HFA. In April 2020, the FDA approved a generic version of Proventil HFA, a popular inhaler. Being brand new, these generics have yet to drive down competition, but they will in time. Rest assured that, for inhaler prices, the calvary is coming. For now, compare prices at PharmacyChecker.com.

How Much Do Inhalers Cost With Insurance

The cost of an inhaler with insurance varies by provider, plan, and coverage stage. For example, even if your Medicare Part D plan covers your inhaler, you might have to pay 100% out of pocket until you reach your Part D deductible.

Another factor that affects inhaler prices with insurance is your plans formulary. Each insurance plan has its own drug formulary, which ranks drugs in a tier system. The lower the tier, the less youll pay for the drug. Generic inhalers like albuterol are usually low-tier drugs and, therefore, have a lower copay or coinsurance. Brand-name inhalers like Symbicort are usually placed on a higher tier and more expensive.

Cost Of Asthma On Society

From 2001 to 2011, the number of people with asthma grew by 28 percent. This constant rise in asthma means the cost of asthma has also grown. In 2002, the total cost of asthma in the United States was $53 billion. In 2007, the cost of asthma grew to $56 billion. This is an increase of 6 percent. The total cost of asthma includes both direct costs, like medicines and hospital stays, and indirect costs, like missed work days and productivity. These numbers show that the current cost of asthma on our society is important. We need to do something about this issue.

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The Steep Cost Of Breathing

The medications that keep Karen Bumgardner breathing are expensive. At $711, one puff of Trelegy Ellipta, a long-acting inhaler she uses daily, costs about $24. The 40-year-old Cleveland County resident also uses about $100-a-month on rescue medications to help her breathe during an attack, including an albuterol inhaler and nebulizer.

Bumgardner has eosinophilic asthma, a difficult-to-control subtype of airway dysfunction brought on by an overactive immune system. Like many people with e-asthma, Bumgardner is on a complicated regimen of antihistamines and other drugs, all to keep her lungs open and functioning. In addition to Trelegy, Bumgardner requires a monthly injection of the biologic drug Dupixent, a targeted, but expensive treatment that costs more than $3,000 a month.

Bumgardner, who up until recently worked as a licensed practical nurse at an assisted living facility, has a high-deductible insurance plan that costs $300 a month in premiums alone. Between coronavirus concerns and her health, Bumgardner can no longer work. Her husband, a plumber and pastor, works three jobs to support them both.

Bumgardner can only get these medications because she qualifies for free medicine through programs run by the pharmaceutical companies that make Trelegy and Dupixent. But these programs only pays if she stays insured.

The prices of asthma inhalers even old drugs, such as inhaled corticosteroids have remained high ever since.

An issue of access

No one solution

How Environmental Concerns Have Made Inhalers More Expensive

Up until 2005, available inhalers contained chlorofluorocarbons , a greenhouse gas that is known to destroy the ozone layer. They were affordable and effective. At the time most products that contained chlorofluorocarbons, like packing materials and refrigerants, were banned per an agreement intended to protect the ozone layer called the Montreal Protocol. Unter this agreement, inhalers were considered essential medications and were exempt.

But this exemption was overturned in 2005 with some help from pharmaceutical lobbyists. From 2005 to 2010, Pharmaceutical manufacturers paid lobbyists over $500,000 to work to ban old CFC inhalers, with the argument of environmental protection. But, why would manufacturers spend money to ban CFC inhalers, ultimately deeming their products illegal and unsellable?

Think of it this way, in order to remove the CFC from an inhaler, manufacturers only have to substitute the propellant used, without touching the active ingredients. This means that manufacturers could rebrand their product, with little to no drug research and development costs, and add a completely new patent protection to their product that could grant them market exclusivity. And this is just what they did.

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Safer Ways To Lower Drug Costs

Medications are the biggest expense for people with asthma, says Bernstein. But there are ways of lowering your cost.

• Ask your health care provider and your pharmacist about taking generic medicines instead of brand name drugs. Although there are a limited number of generic asthma medicines available, they can be substantially cheaper, says Mayrides.
• If you have health insurance, look into mail order prescription plans, recommends Bernstein. “You can sometimes save quite a bit of money with mail order,” Bernstein tells WebMD. “For instance, you might get three prescriptions for the price of two.”
• Edelman says that in some cases, using older and out-of-fashion medicines may be a good idea. “When I have a patient who is in especially difficult financial circumstances, I rely on drugs that many physicians no longer use,” Edelman says. He says that while dyphylline may have greater side effects than newer drugs, it works well and is inexpensive. In some cases, he also uses the oral corticosteroid prednisone. “It’s a very good asthma drug and it’s very cheap,” he says, “However, the side effects are substantial if you use it for a long time.”
• You could also ask your health care providers for free samples of prescription drugs. While it is not a long-term solution, it could help you make it through a particularly difficult stretch.

Working With Your Doctor

Experts stress that you should be honest and direct with your doctor about your financial situation.

“Patients need to be up front,” says Edelman. “I know it can be embarrassing. But if you can’t afford a medicine, you need to look your doctor in the eye and say so. Then your doctor may be able to come up with a new solution.”

You need to advocate for yourself. “People need to be proactive,” says Bernstein. “They need to be asking their doctors and pharmacists about any ways to lower the cost of their treatment.”

Edelman says that doctors need to be more sensitive to a patient’s finances.

“As doctors, we should be doing a better job of helping people with limited resources,” says Bernstein. “We need to be more creative. We need to help them find ways for them to get the treatment they need.”

Whatever you do, don’t ignore your condition. If you haven’t had an asthma attack recently, you might be less careful about your treatment than you should be, says Edelman. It is easy to let your treatment slide, especially if your finances are tight.

“Ignoring your asthma isn’t good for you and it doesn’t make sense financially,” says Edelman. An asthma attack — whether yours or a family member’s — could force you to take time off from work. Losing that income can be a devastating blow to your finances.

“I always tell people to make their asthma care a financial priority,” he tells WebMD. “It will save you money in the long-run.”

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Savings Tip #: Use Your Health Savings Account

If you have a plan with a high deductible, you may want to considering enrolling in a Health Savings Account that you or your employer can pay into. You can use the funds from your HSA on qualified medical expenses , including prescriptions purchased using a discount card. For more background on what an HSA is and how they work, take a look at this article.

Proper Management & Inhaler Use

The key message from the Asthma Society of Ireland is to gain control of your asthma, rather than letting asthma control you. With the help of an asthma management plan, which can be obtained from the ASI and completed in discussion with your doctor or nurse, you can bring your asthma under control. Then you can work on gradually reducing the medication to the point where you can find the minimum amount of medication required to maintain control of your asthma.

We strongly advise people to use peak flow meters and develop their own asthma management plans so that they can get the early warning signs of their asthma deteriorating and they can increase their medication, says Dr Shanahan.

The trick is to try to find out what is the minimum level of medication that keeps them under control, so people can control their asthma as cost-efficiently as possible and avoid the exacerbations that end up in the emergency department, which is distressing, risky and expensive.

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Is The Cost Of Fasenra Covered By Medicare

Maybe. This depends on your particular Medicare plan. Not all plans cover every medication. Certain plans may not cover biologic drugs. Or your doctor may have to provide prior authorization to get Fasenra approved by your Medicare plan.

To learn more about whether Fasenra is covered by your plan, call your plan provider representative, or ask your doctor.

So How Can I Save On Inhalers

• Talk to your doctor about an inhaler that has a generic. In recent years, as patents have worn off, more and more inhalers have gone generic. Fluticasone/salmeterol , and albuterol are two of the more popular inhalers that have gone generic recently.

• Use a manufacturer coupon or patient assistance programs. Some manufacturers offer programs that can help you afford your prescription. Call your inhalers manufacturer to see if there are any programs you qualify for.

• If you have insurance, make sure your brand is on your formulary. The majority of plans do offer preferred coverage for some inhalers, but if for some reason your plan doesnt cover your preferred inhaler, talk to your doctor about submitting an appeal.

• Use a GoodRx coupon. GoodRx offers discounts for all FDA approved inhalers online. A discount can save you up to 80% on your out of pocket cost. Every little bit helps!

• Try to appeal your coverage. If you have insurance and your plan doesnt cover your medication, ask your doctor about submitting an appeal, Some plans require prior authorizations meaning you need permission from your insurance plan and a special request from your doctor before you can fill your prescription. If you have insurance, call your provider and ask how to get this process started.

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Is Exercise Good For Asthma

Although exercise may seem like a trigger for asthma, it is actually essential for overall lung health. By exercising every day, you increase the amount of oxygen your body can use, which helps with breathing. Some people may only have exercise-induced asthma and have difficulty breathing when doing a lot of physical activity. However, these symptoms can be managed, and people with asthma can participate in all kinds of exercise.

Why Prescription Drugs Are So Expensive In The Us

Every one of us has faced illness at some point in our lives and many of us never recovered due to multiple reasons. We all know the pain and sufferings that we bear during any disease, after injury or surgery. Imagine not feeling fresh and energetic, because you are sick and need medical care but once you reach the pharmacy with your prescription, you got to know that you cannot afford the prescribed medicine. What will you do?

This situation is not imaginary in fact, the above scenario is faced by many Americans in their daily lives. According to the Economic Cooperation and Development, Americans spend $1,200 in a year on medication. The number can be taken as the greatest amount that people around the world in any developed country would spend on their medications.

Not only this, pharmaceutical companies have raised the prices of most commonly used prescribed medicines that treat diabetes, asthma, and high cholesterol. These medicines are the ones that are not covered by the prescription coverage offered by insurance companies due to their excessively increasing rates. This was the reason whenthe Kaiser Family Foundation study came out in 2015, that said that every fourth American face troubles in paying for their medications expenses. But couldnt find the answer to why are prescription drugs so expensive in the US?

In this article, we will share some light on the reasons why prescription drugs cost so much in America.

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What Are The Costs Of Asthma For Those With Health Insurance Coverage

• Americans suffering from asthma are much more likely to have health insurance than those that do not have asthma. 5
• Children with asthma were more likely to have full year health insurance than adults. 5
• Those suffering from asthma tend to have trouble paying for health care. For example, they might have trouble paying for medicines or visits to an asthma specialist. But more of these reports come from those with no or partial health coverage. 5
• A person with asthma that does not have insurance visits the emergency room more than a person that has health insurance. 5
• Those with asthma that have a low income and need to cover the costs of asthma treatment may be able to get Medicaid. Families that have children with asthma that do not qualify for Medicaid may qualify for the Childrens Health Insurance Plan. 6
• People with asthma have much higher out-of-pocket costs. They are the most likely to continue using their medication even if they have trouble paying for it. 7
• One study showed that patients getting treatment pay more out-of-pocket costs. This includes those that did or did not have an asthma attack in the past year, compared to those that did not get treatment. 7
• A study showed that 16 percent of people with asthma reported high health costs, spending more than 10 percent of their income for out-of-pocket expenses. These people were also the most likely to not keep receiving treatment. 7

Unregulated Pricing For Pharmaceuticals

In contrast to other developed nations, pharmaceutical pricing is not regulated by the United States government. This means that drug companies are free to set their own prices for medications without any regulation and oversight in the United States while the same medication may sell for significantly less in other countries.

According to a report by RAND, the cost of drugs in the United States is on average 2.56 times as high as in other developed OECD countries and annual price increases continue to rise faster than the rate of inflation, according to AARP.

With an estimated monthly cost of $619.92, according to the manufacturer, people who suffer from asthma and COPD will need to pay a high price for this medication until a generic alternative becomes available.

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How Much Do Inhalers Cost Without Insurance

According to Dr. Gupta, asthma inhalers can be separated into two different categoriesquick-relief medications and control medications .

Short-acting inhalers, or rescue inhalers, help when youre experiencing asthma symptoms, or your asthma is not under control. This medication should only be used as neededideally, youd never have to use it. Everyone with asthma, whether mild or severe, should be prescribed a rescue inhaler. Inhalers of this category include short-acting beta-agonists, such as albuterol inhalers.

Long-acting inhalers, or maintenance inhalers, help with the inflammation in your airways in cases of moderate to severe asthma. These inhalers are not designed to provide quick relief in the event of an asthma attack. Instead, they should be used to help manage and control long-term asthma symptoms.

These medications need to be taken daily to be effective. Depending on the prescribed medication, this may mean once daily or multiple times per day. Inhalers of this category include long-acting beta-agonists, inhaled corticosteroids , and combination inhalers that contain both a long-acting beta-agonist and corticosteroid.

The cost per inhaler will typically vary based on the type of inhaler that it is and whether its a brand-name or generic drug.

Why Are Asthma Meds So Expensive

If my daughter doesnt take her asthma medication, shell end up in the ER. Im not exaggerating. Just ask Aaron, whom Ive called at late hours asking for help caring for her. She tends to get attacks at night. If we cant get her breathing well enough, there would be nowhere else to go but the ER. Once an ER visit resulted in a three-day hospital stay. This costs the system a lot of money, the patient a lot of concern, to say nothing of the heartache and lost productivity of her parents and loss of attention they can provide to the patients sister. We all want the patient to stay out of the ER.

I think about this every time I refill her medication at the pharmacy. Total monthly cost runs to about $45. And yes we use generics. Thats not a lot for my family, but it is enough to get my attention. It is enough that I think about cost every time she fails to breathe in her inhaled dose properly, forcing us to use another. Thats medication, and money, wasted. Its enough money that it is likely many families with fewer resources would try to skimp, to skip doses, to go without filling prescriptions, and, yes, to run the risk of landing in the ER.

Asthma medication is exactly the type of health product that should be free, or nearly so, especially for low-income families. I cannot imagine many would take the meds for fun. I dont think skin in the game causes patients to avoid overuse. All I think it does is risk more asthma attacks and more ER visits, even more deaths.

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