Asthma's New Expense
Phaseout of inhaler leaves patients gasping with sticker shock
Corrected on 8/30/2007: An earlier version of this article incorrectly reported that GlaxoSmithKline had committed to freezing the price of Ventolin HFA until December 2008. GSK's commitment runs through December 2007.
Like many asthma sufferers, Marty Marth was surprised to hear a news report months ago that her medication was being phased out because of its effect on the environment. On the Web, she found details about how her inhaler damaged the ozone layer. But the impact on her own life became clear only this summer, when she took her new prescriptions to a pharmacy near her Branford, Fla., home. "When they told me the price, I almost fell to my knees," she says.
Instead of paying $22 for generic albuterol, a 26-year-old drug that relaxes airway muscles, Marth faced a $148 bill for two different medicines. The first was albuterol with a new ozone-friendly propellant, sold for $36 under the brand name ProAir HFA. Even more damaging to her pocketbook was the second medication, Flovent HFA, with a hefty monthly cost of $112; her doctor had used the Food and Drug Administration-driven switch as an opportunity to add that inhaled anti-inflammatory, to be used daily to reduce the need for albuterol, to her therapy plan. With no health insurance, the costs are all out of pocket for Marth, 59, a writer who lives on less than $20,000 a year. "When you're asthmatic, you don't have a decision about whether or not you buy these things," she says. "It's buy it, or die. What choice do I have but to go into my savings and buy it?"
Marth is among those hardest hit by one of the few Bush administration decisions that environmentalists might laud. The FDA is, in effect, retiring the widely used, generic form of albuterol because its spray propellant contains chlorofluorocarbons. CFCs have been largely banned under the 1987 Montreal Protocol because they destroy the ozone that guards us against the sun's rays, but a few "essential uses" remain. In March 2005, the FDA said it would remove albuterol from that category because CFC-free versions were available—brand-name formulations that happen to have patent protection. The agency calculated that the change, which will go into full effect in December 2008 but is already being felt, will raise albuterol costs for patients and their insurers by $1.2 billion per year.
That translates into a windfall for GlaxoSmithKline, Schering-Plough, Sepracor, and Teva Specialty Pharmaceuticals, the four manufacturers of CFC-free inhalers. More difficult to quantify are the additional brand-name drug sales that may occur as an indirect consequence of the FDA action, as doctors review patients' asthma control plans and—as in Marth's case—prescribe one of several newer preventive medications that are far more expensive than albuterol.
Health professionals generally believe that too many patients relied on albuterol, even though it should be used only occasionally as a "relief" inhaler. They say albuterol offers quick but temporary help, leaving the underlying inflammation untreated and potentially leading to permanent airway damage.
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