Asthma Inhalers Cost a Ton of Money. Do They Have To?

Last year, the Inflation Reduction Act put a cap on insulin costs for Medicare enrollees, with seniors only paying $35 per month’s supply. The policy—reinforced by a bipartisan chorus calling for more affordable drug prices—pushed insulin manufacturer Eli Lilly to announce that it would sell many diabetes medications for the same price across the board. Then in March, a group of senators, some whose policy could not be more different, introduced the Affordable Insulin Now Act, which would cap 30-day supplies of insulin at $35 for good.

It’s hard to overstate the effect of that shift: Nearly $27 million Americans have diabetes, which insulin treats. In the years leading up to the price caps, dozens of diabetics died because they had to ration the drug, which could cost hundreds of dollars per vial.

But diabetes is hardly unique. Under a healthcare system powered by profit margins, numerous effective and mass-produced drugs fall out of reach for patients. Consider asthma: Around one in ten Americans have the condition, which is a disease of the airways leading into the lungs. The airways become inflamed and those with the conditions can experience a combination of breath shortness, wheezing and coughing. It kills about 10 people per day, and collectively costs the healthcare system and patients around $50 billion per year. Like diabetes, asthma permeates poor communities and communities of color at much higher rates than wealthier and whiter zip codes. Plus, asthma treatment—like insulin—is not cheap.

“These medicines are really expensive. Really expensive,” says Dr. Linda Rogers, a professor of medicine and clinical director of the Adult Asthma Program at the Mount Sinai National Jewish Health Respiratory Institute. “Asthma is one of the most expensive chronic conditions to treat.” To be sure, common asthma medications like inhaled bronchodilators can be more expensive to manufacture than oral medications for other illnesses. But at the end of the day, the technology is decades old and the number of affordable generic options is limited by the pursuit of profit above all else. “In other countries there are pretty inexpensive generics that people are allowed to use,” she says. Less so in the United States. One common asthma treatment, Spiriva, costs about $50 in France. It costs five times that here.

Without insurance the cost of an inhaler can run you around $400. Like with insulin, the Inflation Reduction Act has enabled Medicare to more actively negotiate other drug costs, which could be promising, as dropping Medicare drug costs tends to affect the broader market. Further, states like New York and New Jersey have implemented resources to offer treatments to people at lower costs, and they’re typically covered by Medicaid, but the fact remains: A condition that is most common amongst the needy is also infamously expensive.

It seems that the condition would be a noble mantle for a prominent elected official to pick up, like insulin costs. Why it hasn’t happened yet perplexes experts like Dr. Rogers. “I don’t really have a good explanation for that,” she says. “On a population level, the effects of these costs and the costs being driven by the vagaries of our system are huge.”

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