The in the U.S. over the past decade and a half.
Author
Ana Santos Rutschman
Professor of Law, Villanova School of Law
The jump – in some cases from around for an inhaler – has meant that patients in need of asthma-related products to buy them. Others simply them.
To make matters worse, asthma lower-income patients. Black, Hispanic and Indigenous communities have the . They also shoulder of asthma-related deaths and hospitalizations. Climate change will likely and, consequently, these disparities.
I’m a health law professor at , whether patients can get the medicines they need. And I’ve been watching this affordability crisis closely.
In many ways, it shows what happens when law and policy decisions aren’t aligned with public health needs. The good news, however, is that there finally seems to be some political will to rein in the price of asthma meds.
Why inhaler prices are skyrocketing
In 2008, the U.S. Food and Drug Administration that use chlorofluorocarbons, or CFCs – which were once widely used as propellants – because they can damage the ozone layer. The FDA was following a timeline set by an environmental treaty, the , which the U.S. ratified in the late 1980s.
From 2009 onward, CFC inhalers were phased out and replaced with hydrofluoroalkane, or HFA, ones, which are more environmentally friendly. They’re also a lot pricier. For patients with insurance, the average out-of-pocket cost of an inhaler rose from $13.60 per prescription in 2004 to $25 immediately after the 2008 ban, .
Today, the of an albuterol inhaler is $98. Unlike CFC inhalers, which have , HFA inhalers are . While hasn’t changed, the switch to a different device allowed companies to increase their prices.
In 2020, the FDA finally approved the of an albuterol inhaler. But generic competition still isn’t robust enough to lower prices meaningfully.
Patients with good insurance or even nothing. But uninsured patients face steep market prices, and as of 2023, there were uninsured Americans. affording their asthma meds, the CDC has found.
The same asthma medication for which U.S. patients pay top dollar is available elsewhere at much cheaper prices. Consider the following case for inhalers. The pharmaceutical company Teva sells , a corticosteroid inhaler, in the U.S.
In Germany, Teva sells that same inhaler for $9.
Seeking meds from Mexico and Canada
Some U.S. patients have traveled abroad to obtain cheaper asthma medication. After the 2008 ban on CFCs, it became common for patients to to purchase albuterol inhalers. They were sold for .
A study of inhalers available to U.S. patients in Nogales, Mexico – about an hour south of Tucson, Arizona – found that Mexican products were . But researchers found some differences in performance, suggesting that American patients who use them could be getting a slightly different dose than their usual.
There have also been reports of Americans turning to Canadian pharmacies to purchase asthma inhalers at much cheaper prices. In one case, a U.S. pharmacy would have charged $857 for a three-month supply. A patient obtained it for .
One potential fix: Importing cheaper meds
U.S. law has long personal importation of pharmaceutical drugs. However, a recent development could to import cheaper asthma drugs.
In January 2024, the the importation of certain prescription drugs from Canada for the first time. , this authorization is limited to Florida, and it covers only drugs for HIV/AIDS, prostate cancer and certain mental health conditions.
Should it prove successful, the program could serve as a blueprint for other states.
Another possible solution: Price-capping
Policymakers could also try borrowing a page from the insulin playbook. Insulin prices before Congress acted, capping the cost of insulin for Medicare patients. The 2022 established an out-of-pocket ceiling of $35 per month for prescription-covered insulin products.
If this cap had been in effect two years earlier, it would have saved 1.5 million Medicare patients about $500 annually, . It also would have saved Medicare .
A similar approach could be taken for asthma meds.
Congress could create an asthma-specific rule similar to the insulin case. Or it could place provisions for asthma-med prices into a larger piece of legislation.
While this approach depends on the political environment, there are signs the government is becoming more willing to act. In January 2024, the U.S. Department of Health and Human Services to discuss the problem with manufacturers and other stakeholders.
It’s a start. And – together with other measures – it brings some hope that asthma meds might soon become more affordable to those in need.
Ana Santos Rutschman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
