Asthma is one of the most expensive diseases in the United States (US). Despite recent actions from inhaler manufacturers to lower drug prices, there is still much to be done to make asthma treatment affordable.
More than 22 million Americans have asthma. For half of adults and almost 90% of children, it’s caused by allergies. These rates have grown since 1996, likely due to climate change.
To manage asthma, there are two main types of inhalers: controllers for daily maintenance and relievers for flare ups. Based on symptom severity, patients may use both kinds. Patients may also choose to treat their underlying allergies with immunotherapy, antihistamines, and/or by avoiding allergy triggers altogether.
But the expense of some of these asthma treatments puts them out of reach for many patients.
One study of nearly 130,000 participants found that allergic asthma patients have 39% greater annual total health care costs and 79% greater annual asthma-related health care costs than non-allergic asthma patients. They had significantly more pharmacy claims, outpatient visits, and emergency department visits. They also were more likely to have undergone skin and/or blood allergy testing.
All told, the authors calculated that allergic asthma patients paid over $1100 more per year than non-allergic asthma patients. But that didn’t even include the costs of over-the-counter treatments, like antihistamines and nasal sprays, or the costs of immunotherapy (and not just the medicine itself but also weekly copays travel expenses). Nor did their results indicate how well patients’ asthma was controlled, and health care costs are typically higher for patients with poorly controlled asthma.
Further, an investigation by a US Senate Committee found that asthma medications cost significantly more in the US than they do elsewhere. For example, AstraZeneca charges $645 in the US for an inhaler that only costs $49 in the United Kingdom. Similarly, Teva Pharmaceuticals charges $286 in the US for an inhaler that costs $9 in Germany.
To be fair, some drug companies are addressing these high prices.
For example, AstraZeneca and GSK are following the example of major insulin manufacturers and reducing their prices. While these companies are implementing $35 monthly price caps on inhalers, eligibility varies, and patients are still years away from actually seeing the benefits.
Some companies are authorizing generic options for their brand-name inhalers, too. For instance, GSK recently discontinued Flovent, a frequently prescribed maintenance inhaler, because they’re making a cheaper, generic version instead. (It’s worth noting that this abrupt change caused chaos for some patients who had to scramble to find a comparable prescription for the interim.)
Despite these positive changes, the overall system remains flawed. Consider patent protections and Food and Drug Administration-granted exclusivity protections.
With the goal of rewarding innovation, the US Patent and Trade Office allows drug companies to sell new medications for a set period of time without any competition, typically 20 years. The Food and Drug Administration may also give manufacturers a monopoly for different periods and reasons. However, because of these protections, over 50 patents were approved for brand-name inhalers from 1986 to 2020, with only three facing generic competition afterwards. What’s worse, some drug companies partake in unethical practices to extend their market control even longer.
There are ways to remedy this though. The Senate recently passed a bipartisan bill that could prevent product-hopping, one of those unethical practices where manufacturers stop producing a nearly expired product and start selling a new, very similar version, effectively restarting their patent protection. This has been common with Albuterol rescue inhalers, costing payers and patients billions of dollars. If signed into law, this bill could increase the speed at which generics hit the market, ultimately leading to lower prices for patients.
An even more significant change would be if the US moved towards value-based pricing, where prices are based on drug effectiveness and the quality of life improvements patients see. A variety of cost analyses can be utilized to determine fair prices, and this approach has been successful in Europe and Australia with inhalers.
Asthma treatment is expensive, full stop. But asthma sufferers shouldn’t have to worry about how to pay for it. It is possible to minimize costs, but federal policies will need to balance profitability, affordability, and innovation.
Research for this piece was supported by Arnold Ventures.
