More than 25 million people in the U.S. rely on respiratory inhalers to relieve wheezing, shortness of breath, coughing and additional asthma-related symptoms. In an attempt to reduce their environmental footprint, the Food and Drug Administration (FDA) placed a ban on the production of ozone-depleting inhalers.

This 2008 ban changed the type of albuterol inhalers available to asthma patients, and eliminated the use of inhalers with chlorofluorocarbon (CFC). These generic medications were replaced by the more expensive alternative that uses hydrofluoroalkane (HFA), a more environmentally friendly inhaler.

A recent JAMA Internal Medicine study found that this inhaler ban has been more costly, as the average asthma patient is paying twice as much for their medication. UMN’s Health Talk turned to co-author of the study, Pinar Karaca-Mandic, from the School of Public Health to help explain the ban and its costly impacts on asthma patients.

Health Talk: Was there anything you found particularly interesting or surprising regarding the results of increased inhaler costs?
Karaca-Mandic: It was interesting to see that generic CFC albuterol inhalers were gradually phased out by U.S. health plans well before the FDA-mandated date of removal of the inhalers from the market.

We were surprised that the use of HFA albuterol inhalers increased concurrently with very little impact on the total albuterol inhaler use despite the high out-of-pocket costs of the branded HFA inhalers. Ultimately, the main effect of the policy resulted in a large out-of-pocket increase for patients who need their albuterol inhaler.

HT: What are the effects of the cost increase on patients requiring inhalers?
Karaca-Mandic: We found that on average costs per prescription increased from $14 to $25 in the first quarter of 2009 after the inhaler ban went into effect. By the end of 2010 prices declined to $21. While there was much variation across health plans, almost half of all plans had increases in the out-of-pocket albuterol inhaler costs exceeding $10.

HT: What are the implications of the study’s findings?
Karaca-Mandic: Before 2005, CFC albuterol inhalers were considered essential medications, and they were exempt from the Clean Air Act. When the FDA reversed this policy in 2005 and announced that CFC inhalers were to be withdrawn, the only albuterol inhalers left on the market were branded HFA inhalers. Our findings suggest that this policy led to a substantial increase in out-of-pocket costs of individuals and a modest decline in albuterol inhaler utilization.

From a broad policy point of view, I believe it is important to further investigate the balance between the increased cost burden of patients with asthma and environmental benefits of removing CFC albuterol inhalers.

HT: What can be done from a policy perspective to address the cost increases?
Karaca-Mandic: As the FDA moves forward banning other drugs due to environmental concerns, the availability of generic medication in the market can be an important consideration for assessing whether patients have affordable access to care.

~ Post originally published on the Health Talk blog and written by Katie Huggins, AHC Media Team