By Jennifer Porter Gore | Word In Black

(WIB) – When one of the largest manufacturers of asthma inhalers announced it would cap out-of-pocket costs for its product starting in June, it was framed as a big win for Americans with asthma, a disproportionate number of whom are Black. 

The move by pharmaceutical giant Boehringer Ingelheim comes amid news that inhaler prices have soared, with a single inhaler costing as much as $600 in the U.S. By contrast, the same medication costs as little as $7 overseas. 

Asthma advocacy organizations, and Sen. Bernie Sanders, a Big Pharma watchdog, called it good news for uninsured patients forced to pay top dollar for the lifesaving drug. But it’s unclear how many of the 41 million Americans with asthma or COPD — most of whom are Black and Latino — will benefit, in part because the price cap may not include people using Medicaid or Medicare. 

“This is obviously good news for some patients but it doesn’t address the problem at as large a scale as it would seem,” Ana Santos Rutschman, a health law professor at Villanova University said in an email interview. Rutschman studies patients’ ability to access medicine, including affordability issues.

“The fact that many elderly patients and Medicaid patients are not the primary targets means that this measure will likely not be of immediate help to the patient populations that shoulder the heaviest burden of asthma/respiratory disease,” typically low-income patients, Rutschman said. 

While the price cut is a good thing, “it’s yet another example of a ‘band-aid’-type of solution that will stop the financial bleeding for some patients,” Rutschman said. But for Black patients in particular, ”it is likely to have a very limited effect.”

Boehringer Ingelheim’s decision to reduce the cost for their asthma and chronic obstructive pulmonary disease inhalers comes as asthma drug prices have skyrocketed over the last decade. 

Along with other large manufacturers like AstraZeneca, GlaxoSmithKline and Teva, Boehringer Ingelheim charges between $200 and $600 for a single inhaler — a drug that asthma patients usually have to buy each month.

In January, during a Senate hearing, Sanders slammed pharmaceutical manufacturers for out-of-control inhaler prices.

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“There is no rational reason, other than greed, as to why GlaxoSmithKline charges $319 for Advair HFA in the United States, but just $26 for the same inhaler in the United Kingdom,” Sanders said. “It is unacceptable that Teva is charging Americans with asthma $286 for its QVAR RediHaler that costs just $9 in Germany. It is beyond absurd that Boehringer Ingelheim charges $489 for Combivent Respimat in the United States, but just $7 in France.”

In announcing the price cut, however, Boehringer Ingelheim’s CEO said his company is taking steps to “support patients with predictable, affordable costs.” 

The U.S. healthcare system “is complex and often doesn’t work for patients, especially the most vulnerable,” said Jean-Michel Boers, CEO of Boehringer Ingelheim USA Corporation. “While we can’t fix the entire system alone, we are bringing forward a solution to make it fairer.” 

Still, inhaler prices have a disproportionate impact on Black people, who are three times more likely to die from asthma than whites, according to the Asthma and Allergy Foundation of America. Its 2020 report, “Asthma Disparities in America,” also found that Black patients are five times more likely to be treated for asthma in hospital emergency rooms compared to whites and that more Black women die from asthma than any other group.

“We welcome this announcement from Boehringer Ingelheim as a step in the right direction when it comes to making asthma medicines affordable,” said Melanie Carver, AAFA’s chief mission officer. “High drug costs are the top barrier to asthma treatment. We are hopeful more action will be taken by all stakeholders to ensure a broad range of asthma medicines are available at an affordable price.”

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While Boehringer Ingelheim’s price cut will help, it’s just one factor that affects drug prices. Pharmacy benefit managers, insurance companies, employers, and federal policymakers also affect what patients pay at the drugstore counter, Carver said.

Indeed, Boehringer Ingelheim’s announcement indicates the price cap will only apply to individuals with commercial insurance or no insurance. 

Rutschman says costs for inhalers began to spike in 2009 after the Food and Drug Administration banned the use of chlorofluorocarbons a year earlier. To comply, drug companies used the more environmentally-friendly chemical hydrofluoroalkane, or HFA, in their inhalers — then hiked prices on the new formula, in some cases more than tripling the price.

Besides being more expensive, the new inhalers are under patent protection, and very few generics are available. Well-insured patients may have little to no out-of-pocket costs for inhalers, but the more than 25 million uninsured Americans still face steep prices. The picture is less clear for Medicaid and Medicare recipients, whose prescription drugs are covered under a convoluted system, in which some drugs are covered and others might not be. 

There are calls for the remaining major manufacturers of asthma inhalers AstraZeneca, Merck, GlaxoSmithKline, and Teva, to follow suit. Meanwhile, some state legislations are looking into price caps for asthma inhalers similar to those enacted on insulin. 

The bottom line is “U.S. patients pay top dollar for medicine that is available elsewhere at much cheaper prices,” Rutschman adds.