Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Why Your Inhaler is So Expensive Now: Going Green at a Price.
Posted in Asthma by Dr. Sharon Orrange on Oct 20, 2009
Many folks have had sticker shock at the pharmacy when going to refill their inhalers, the same inhalers they have been on for years. You must have questions; here are some answers about what is going on.

What is albuterol?
Albuterol is an inhaled beta agonist which works to relax smooth muscle and dilate or “open up” the airways. It is a short acting bronchodilator.

How long has albuterol been on the market?
Albuterol was originally approved by the FDA in 1981 and has been sold as many different brand names: Proventil, Ventolin, Volmax among others.

With the banning of CFCs was albuterol the only inhaler affected?
Yes, albuterol is the most common metered-dose inhaler (MDI) which used a propellant-driven chlorofluorocarbon (CFC) delivery mechanism for inhalation.

Have other countries banned CFC?
Yes, in fact most aerosols (hairsprays, etc) dropped the use of CFC propellants more than 25 years ago. Countries worldwide signed an International treaty called “The Montreal Protocol on Substances That Deplete the Ozone Layer” which called for banning CFC propellants. The U.S. ended production and importation of CFCs for all commercial applications in 1996 but because there was no alternative for the asthma inhaler Albuterol, they were allowed to stay on the market until December 2008.

When did you hear that the albuterol inhaler would be taken off the market?
In 2004 when the Proair HFA was released most Physicians realized this was the beginning of the transition from CFC inhalers to HFA inhalers.

Have there been any complaints?
What are the most common? Cost is by far the most common complaint with the HFA inhalers as there is no generic option. This means patients are paying a much higher copay. Patients also report the HFA inhalers have a slightly different smell and taste and the mist is a little less forceful and warmer coming out of the inhaler. Additionally, you must prime and clean HFA-propelled inhalers to prevent buildup of the drug in the inhalation device, which can block the medicine from reaching the lungs. Each HFA inhaler has different priming, cleaning, and drying instructions.

Would you know why the decision was made to make HFA Albuterol (pro-air) a brand drug as opposed to a keeping it as a generic?
If the drug is the same, why would a different propellant change the status of a drug from generic to brand? ProAir HFA, Proventil HFA and Ventolin HFA are all albuterol with HFA as the propellant and yes, the Albuterol ingredient is the same but the HFA inhalers still had to be tested for safety and efficacy like any new drug, and apply for approval from the FDA just like any new drug.

How long does it take for a brand drug to become generic?
It depends on the drug and the indication for the drug but between 5 and 7 years for most drugs.

Is there any hope of seeing albuterol return as a generic drug any time soon?
ProAir HFA was approved in 2004 and will go generic in late 2009 (early 2010 possibly) and many drug companies will make a generic form of ProAir HFA at that time.

As a Physician, how do I feel about the situation?
To go from inhalers that cost 5 dollars to 60 dollars especially for those who don’t have prescription drug coverage has been awful. There are a couple things that do help: drug samples at the doctor’s office, the nebulizer solution is still generic so some have started using nebulizer treatments at home, and drug companies have set up some help for those in financial need with no drug coverage through the Partnership for Prescription Assistance (PPA) at 1-888-477-2669, or visit them online.

Dr O.
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6
The new HFA propellants put me in the ER three times last Fall. I would appreciated knowing all the components before I paid the big price for the new inhalers. I could have saved myself hundreds of dollars in trips to the Emergency Room. Why are they so secretive about HFA?
By DryRDH  Jun 24, 2010
5
They do have a generic now from Pro-Air. It is sorely lacking! Not only does it not work even as well as the other HFA inhalers, the number of actuations, which by the way you're supposed to keep track of with all the HFAs, is not what they claim. I asked my Dr. to put me on Ventolin. It has an actuation counter built in, works a whole lot better but does cost more & my insurance doesn't pay the same % of cost. I guess because it's not generic. At least it works fairly well. In my opinion this green thing is crap! How much ozone can an inhaler make? Bet not as much as all the flatulence the Gov. spiels out!! Let's face it this disease gets no respect. Debbie
By debbie60  Mar 17, 2010
4
In addition to the dramatic increase in cost, the new HFA inhalers do not work effectively for me at all. My asthma, which had been well under control for years has become worse and worse since the CFC inhalers, which always provided immediate relief of sudden symptoms, were replaced with the new "green" HFA inhalers. I have been prednisone free for years, but I fear I will have to start using it again. There is no question that the HFA inhalers are the reason for my worsening asthma. It is a desperate and helpless feeling. I'm all for protecting the environment, but gimme a break!

Kathy
By kajo55  Mar 09, 2010
3
the cost of drugs in the USA makes me realise that the NHS in Britain has one major advantage: it does not make health care dependent on personal wealth. I pay only a token sum every four months (£16) and that covers all my prescriptions, regardless of the number I need. I get all my Seretide, Spiriva, Ventolin and anything else for that price.
Of course, the NHS only provides certain approved drugs. As far as I know, asthma patients never have problems with this but I know that some new cancer drugs are not available on the NHS because the cost/benefit advantage is considered too small, ie it costs a lot and you're only going to live a few months extra. Tough !
By northerngoose  Dec 12, 2009
2
and they don't work as well! many of my patients complain that it takes more to do less with these inhalers and yet the prescription amounts don't change. it leaves them having to make a decision of whether to 'over medicate' according to the directions given them, or not get the relief they need. most over medicate. quite a quandary.
By tadlem  Nov 03, 2009
1
The shame of it is, to me, that these inhalers don't have to be so expensive, if drug companies would curtail their outrageous profits. There is something wrong when one could get the same medication in Mexico for far, far less than we can in our own country (going green or not!)
By jamsnjazzy  Oct 31, 2009
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