New asthma inhalers look the same but will cost you more

The new generation of asthma inhalers are environmentally friendly and as effective as the older generation that used ozone-harming ingredients.

But there's a catch. The new inhalers cost roughly $30 to $50 in local pharmacies. The older style, which are increasingly hard to find, cost about $15.

Because the Earth-friendly inhalers are relatively new, there is no generic alternative for them, leaving insured patients with much higher copayments and the uninsured footing the whole bill.

"It has a significant impact," said Dr. Cynthia Kelly, director of the pediatric allergy and immunology department at Children's Hospital of The King's Daughters in Norfolk.

Asthma, a chronic respiratory disease, disproportionately affects the poor. Nearly 15 percent of Virginians who have incomes of $15,000 or less have asthma, compared with 6 percent of those with incomes of more than $75,000, according to the state health department.

Most people with asthma are on "other medications as well," Kelly said. "They're already incurring significant costs."

Someone with moderate to severe asthma would typically go through six to eight such "rescue" inhalers in a year, said Kelly, who is co-director of Allies Against Asthma, a regional advocacy group for asthma patients based at Eastern Virginia Medical School.

The U.S. Food and Drug Administration's regulation will ban the sale of the old-style inhalers because they contain chlorofluorocarbons, or CFCs, as a propellant. Commonly used in aerosols, CFCs have been linked to depleting the ozone layer, reducing protection against the sun's ultraviolet radiation. Most manufacturers stopped using them in products long ago, but until recently, an exception has been made for asthma inhalers.

The CFC-inhaler ban doesn't officially go into effect until Jan. 1, 2009, but most pharmaceutical manufacturers have stopped producing them, said Betsy Stoller, a spokeswoman for the Asthma and Allergy Foundation of America.

"We're in support of the transition" to hydrofluoroalkane, or HFA, inhalers, Stoller said. The problem has been that "patients were not aware the transition was occurring."

Stoller said doctors will write prescriptions for the new inhalers without telling their patients about the change. She said the complaints the foundation has heard have been not so much about the price, but about how the inhalers work. While they're just as effective clinically, "it does feel different and some patients say it feels weak."

Public awareness efforts about the transition are under way, including an American Lung Association public service announcement airing nationally in which the new inhalers trounce the "polluting inhalers of yesterday" in a professional wrestling match.

But CFC inhalers easily beat HFA inhalers on cost. The new inhalers enjoy patent protections, which mean their manufacturers have an exclusive right to make them and set prices. Typically, once patent protections run out, generic drug producers start making competing products and prices come down.

Kelly said there are prescription assistance programs for people who qualify and some companies are offering coupons for a free sample, "but that's only for one inhaler."

Kelly said her patients are finding it harder to locate CFC inhalers.

"They often call back when they can't get the old alternative," Kelly said. "They have to do their shopping around."

Pharmacist Lawrence Barlow said he is "down to one company that still makes" CFC inhalers, but he has been able to meet the demand of his customers. Barlow owns the independent Irwin's Pharmacy in Chesapeake. "The old ones are less expensive, and people are still asking for them," he said.

Customers who have insurance that covers the cost of HFA inhalers have generally made the transition, he added.

In anticipation of the change, Norfolk-based Optima Health Insurance Co. moved one of the HFA inhalers to its "preferred" brand-name drug tier that requires a copay of $20 to $30 rather than the $50 or more for drugs on higher tiers, said Deno Sebastian, director of pharmacy for the insurer. Anthem Blue Cross and Blue Shield in Virginia also has the new inhalers on their "preferred" brand tier, said spokesman Scott Golden.

The new inhalers probably will have to be made generically before they can move to the least expensive tier of drug co-pays - typically $5 or $10, depending on the insurance plan. Current HFA inhalers most likely won't lose patent protection until the next decade.

Generic status doesn't affect just insurance copayments; out-of-pocket-costs for the uninsured also are much lower. Kelly said the new inhalers' cost may prompt some patients to decide to try to do without them, putting them at risk when they have an asthma attack, which, in turn, can lead to more costly emergency room visits.

"I'm sure they're out there," Kelly said. "They don't necessarily let their doctor know that."

Nancy Young, (757) 446-2947, nancy.young@pilotonline.com