Inhalers are the most common treatment option for asthma and chronic obstructive pulmonary disease (COPD). These small medical devices play a key role in ensuring the health and wellness of patients managing these conditions. Asthma is a chronic inflammatory condition that narrows and irritates the airways of the lungs that affects nearly 25 million Americans. And yet, despite the prevalence of the condition, and the critical aid that inhalers play in asthma patients’ lives, the cost of these devices keeps rising.

An analysis of the cash price of inhalers shows that cash prices for asthma medication (the drugs administered by an inhaler) have risen 35% over the last few years. The price for Advair climbed from $316 in 2013 to $496 in 2018. It now costs about $537 without insurance. With the ever-increasing prices for asthma medication, it can be difficult to figure out the best treatment plan for your health (and wallet). To help clarify this choice for you, we’ve compared the cost of asthma inhalers and detailed the pros and cons of each.

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What is asthma?

Asthma is a chronic inflammatory condition that affects the passageways to the lungs. Asthma develops over an individual’s lifetime and may vary in severity from person to person. Most people experience asthma symptoms during an “asthma attack” - or, an episode triggered potentially triggered by the factors above, that results in sensations commonly associated with the condition.

These common symptoms include:

• Breathing problems, such as shortness of breath
  
• Coughing episodes
  
• Wheezing while exhaling (a sort of whistling rasp as you breathe out)
  
• Chest tightness
  
  

More severe asthma cases may cause chronic problems such as:

• Difficulty sleeping
  
• Frequent asthma attacks
  
• Increased need for an inhaler (especially after physical activity)
  
  

There is no common cause of asthma, although it is widely agreed that a combination of genetics (inheriting the condition from a parent) and environment play significant roles in who develops it and who doesn’t. Many people with asthma experience infrequent attacks that can lead to wheezing and shortness of breath, while others may experience persistent difficulty breathing.

The most common triggers of asthma attacks are:

• Allergens such as mold, pollen, dust, and pet dander
  
• Physical activity
  
• Pollutants and irritants such as smog and secondhand smoke
  
• Cold air
  
• Respiratory infections (like a common cold)
  
• Gastroesophageal reflux disease (GERD)
  
• Sulfites and preservatives found in food
  
  

In most cases, asthma attacks can be managed with inhaled medication. Because this is often the frontline asthma treatment, it is imperative that patients have access to affordable versions of the prescription drugs administered by these devices.

Asthma Inhaler Cost Factors

Asthma inhalers vary in price depending on your health insurance plan, the type of drug you have been prescribed, and whether or not you can purchase that drug in its generic form. Health insurance

Most healthcare networks cover the vast majority of asthma treatment. This can help defray the high cost of these drugs and lower your copay. However, the CDC estimates that in some states, nearly 20% of adults do not have health insurance coverage for asthma medical costs. This means that a significant chunk of the population has to pay for these drugs out-of-pocket.

If you are insured, talk to your healthcare provider about how much of your asthma care is covered by your plan. In addition, it is recommended that you ask about the different types of drugs available under your plan to determine what fits within your price range. Generic drugs—like albuterol—are significantly more affordable than their brand name version—Ventolin, for instance.

Unfortunately, asthma is most prevalent in lower-income households with less access to health insurance. Overall, the Centers for Disease Control and Prevention (CDC) estimates that asthma cost the US economy around $81.9 billion in care, missed work, and mortality from 2008-2013. These healthcare costs have only gone up since then.

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There are several varieties of inhalant options used for the treatment of asthma and COPD. These are broadly categorized into short-acting (quick-relief) and long-acting (control) medications.

Quick-relief inhalers are used as needed as asthma symptoms begin to occur. Short-acting beta agonists used for quick relief include albuterol (generic for Ventolin and Proair Respiclick) and levalbuterol (generic for Xopenex). Long-acting inhalers control asthma by reducing inflammation and irritation in the airways. These drugs are administered every day—sometimes multiple times per day. Medication used in this category includes long-acting beta-agonists (LABA), inhaled corticosteroids (ICS) and combination inhalers that use both.

Salmeterol (generic for Serevent Diskus) is a long-acting beta-agonist. Mometasone furoate (Asmanex), beclomethasone (Qvar), fluticasone propionate (Flovent HFA) and ciclesonide (Alvesco) are all examples of inhaled corticosteroids.

Combination inhalers (ICS-LABA) use both long-acting beta-agonists and corticosteroids. Combination inhalers include budesonide/ formoterol (Breo Ellipta, Symbicort and Pulmicort), mometasone/ formoterol (Dulera) and fluticasone/ salmeterol (Advair).

Short-acting inhalers are generally cheaper than long-acting inhalers and ICS inhalers are generally cheaper than LABA inhalers. In most cases, patients will be prescribed both a quick-relief inhaler for emergency situations and a long-acting inhaler for overall maintenance.

As seen above, there are generic forms of drugs that are available under brand names. The patents for brand-name drugs drive prices up, making them more expensive than their generic version. Many asthma drugs still have active patents, which means that there is no generic version on the market. However, in 2019 the Food and Drug Administration (FDA) approved generic versions of Proair (albuterol), Advair (fluticasone/salmeterol), and Ventolin (albuterol/ salbutamol).

The price difference between brand name and generic is stark: generic albuterol inhalers cost about $16-$24 whereas the brand name (Ventolin) costs around $50. Similarly, generic fluticasone/salmeterol inhalers cost about $100-$130 whereas the brand name (Advair/ Airduo) costs about $340.80. Brand-name inhalers are 40-50% more expensive than their generic versions, which can drive up your overall medical costs considerably when you consider that these prescriptions must be refilled several times a year.

How to cut inhaler costs

We know that the type of inhaler that you are prescribed, as well as the drug version you are using (generic vs. brand name) all influence price. So, how can you get the treatment you need without incurring massive drug costs? Here are some ideas:

Ask about a generic option: If available, the generic forms of asthma drugs often cost 40-50% less than the brand name. When getting a prescription, talk to your health care provider about whether or not a generic version exists.

Ask about available coupons: Manufacturers often offer coupons to help lower the cost of inhalers. Talk to your health care provider about how to find coupons via the manufacturer or pharmacy retailer to save some money on your prescription.

Shop around: Before you pay for an inhaler out-of-pocket, shop for the best price for your medication. Sesame offers affordable prescriptions for the generic version of asthma drugs, often nearly 60% less than what you’d pay through insurance. You can also use Singlecare’s asthma inhaler price list to compare the price of different inhaler drugs and make the most informed decision about the treatment plan that’s best for you and your finances.

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