Inhalers show ‘money trail’ affecting medicine prices

When I read the news that three out of four manufacturers of asthma and COPD inhalers have decided to cap the price to the patient to no more than $35 a month, it came as a shockingly pleasant surprise. The drug companies would like us to believe that they cut prices from a sense of civic responsibility. If anyone believes that I am the listing agent for the White House as Airbnb.

As a physician who specializes in pulmonary medicine, I prescribe inhalers numerous times. Medications that have been around for years, have become prohibitively expensive. The same inhaler that could be purchased for $40 or less is now sold for ten times the price. There is no reason why these medications should have become so expensive. The answer is definitely not R&D.

These are older drugs, and all the R&D was done years ago. The simple answer is the desire to increase profits for the company and its shareholders. This is where the money trail leads. It is an example of the failure of an unrestrained capitalistic system.

Although Sen. Bernie Sanders would like to take a victory lap claiming that the change was from public hearings he chaired, and still others point to the changes in Medicare prices that the Biden administration has suggested for a few drugs, the real reason appears to be aggressive actions taken by the 35-year-old chair of the Federal Trade Commission, Lina Khan. She went after drug companies, filing suits arguing that the patents the drug companies had claimed listing their old inhalers as new were patently false.

U.S.-based companies Boehringer Ingelheim, AstraZeneca and GlaxoSmithKline all announced the monthly cap. The one company that has stuck to the high prices is the Israeli-based company Teva, which is the largest manufacturer of generic drugs in the world.

For prescribers, drug and insurance company shenanigans easily fall into Alice in Wonderland territory. Welcome as the price cap is, it is only a small part of a huge drug price and shortage problem.

One drug company has stopped manufacturing a popular brand-name inhaler Flovent. The direct result is the only similar inhalers, generic versions of the Flovent and Asmanex, are now in permanent short supply. Boehringer Ingelheim is cutting the list price for Spiriva HandiHaler but not Spiriva Respimat, which is the same medicine in a different delivery system.

Many pharmacies will not stock all inhalers on their shelves. A local pharmacy may tell you that the covered inhaler must be obtained from the warehouse, which may take a day or more. If you need an inhaler right away, then you must purchase an alternative that could be a generic version, which should be less expensive but in fact may cost far more.

When I reached out to a major insurance carrier to find out what inhalers are covered, they sent me to a sister entity. Searching this entity’s website revealed that only two of many inhalers were covered, neither of which is recommended as first line by carefully curated studies. Which means that I cannot follow the evidence-based guidelines suggested by the NIH. I may as well throw these guidelines into a trash can.

Common sense is conspicuous by its absence from insurance company regulations. One insurance company would cover only a breath-actuated version of the inhaler, regardless of the child’s age, and not the pressurized cannister type inhaler attached to a valved holding chamber. Children 5 and younger are unable to use the breath-actuated inhaler, because they cannot inhale on request. Which infant or toddler can do that?

Thrown into this conundrum are the entirely unnecessary middlemen, the Pharmacy Benefit Managers. Their only role appears to be to make money for themselves.

Now at least I can tell parents and patients who call me, that thanks to aggressive application of laws on the books already, Lina Khan as chair of FTC, has brought about real change. They can now get the inhaler for a much lower price. Even this price may be too high for many of my patients, especially if they are on two inhalers, one for control of the illness and the other for rescue, and additionally may need antihistamines, steroid nose sprays and extremely expensive topical skin steroids for concomitant allergies and eczema.

If the drug price and availability problem is broadened to other classes of medication, like antibiotics, chemotherapy for cancer and biologicals for auto-immune illnesses, the problem is infinitely worse.

• Javeed Akhter is a physician and free-lance writer from Oak Brook.