The Bill That Took My Breath Away

Inhaler drugs are decades old, but treating asthma in the U.S. costs billions more than it should. Here’s why.

Eearly in the spring of last year, I suddenly found that the easy jaunt up the three stories to my condo had turned into a frightening ordeal. After getting up the stairs, I had to sit down for several minutes to catch my breath. I couldn’t even make it through my usual Sunday stroll around the local reservoir without taking a break.

My doctor’s diagnosis: My asthma, which had been in check for years, had intensified. The rescue inhaler I had been using to provide relief for occasional wheezing was no longer sufficient.

He prescribed a maintenance inhaler to reduce the likelihood of asthma flare-ups. The inhaler works only if it is faithfully used every day. And sure enough, after three weeks, the stairs no longer seemed as daunting as Mount Everest.

“There’s been a lot of that activity in the last 20 years. But the core three ingredients in the inhalers have not changed.”

But something else was now taking my breath away: the cost of that maintenance inhaler. I happened to glance at one of the “Statement of Benefit” notices my insurer sends after a claim, correspondence I typically consign to the junk mail pile. The notice listed the full cost of my asthma inhaler at $325 — about as much as a 40-inch LED television. Since a single inhaler lasts just one month, I calculated that a year’s supply would come to $4,000. Fortunately, as I’ll explain later, my copay was just a fraction of that amount.

That drug companies can command such high prices for potentially lifesaving medication is under new scrutiny following a spike in the cost of EpiPens, injection devices used to reverse severe allergic reactions to bee stings, peanuts, and other allergens.

I had first used maintenance inhalers in the early 1980s, when I got my diagnosis of asthma. I was surprised to find that three decades later, there was still no generic version. After all, the active ingredients — steroids — are hardly exotic. It’s what happens to them in the laboratory that keeps generics off the market.

“The original drug may go back decades,” said John Fahy, director of the Airway Clinical Research Center at the University of California at San Francisco. But if pharmaceutical companies “tweak the formulation, they can get a patent extension.”

“Delivery devices, formulation changes, modifying the drugs so they last longer — there’s been a lot of that activity in the last 20 years,” he continued. “But the core three ingredients in the inhalers have not changed.”

One of those changes came about within the last decade — at the behest of the federal government.

Remember the ozone layer scare back in 1980s? Huge gaps were opening in that critical atmospheric layer that protects us from skin cancer-causing ultraviolet radiation.

The culprit was chlorofluorocarbons (CFC), chemicals compound commonly found in air conditioners, refrigerators, and aerosol sprays. Under the Montreal Protocol, which entered into force in 1989, the world’s leading countries agreed to phase them out.

The compound also served as a propellant in asthma inhalers, but their use accounted for just one-tenth of one percent of CFCs emitted into the atmosphere. Still, the Food and Drug Administration announced in the late 1990s that it was considering banning CFC inhalers once the pharmaceutical industry came up with alternatives.

Erik R. Swenson, a pulmonary care specialist with the Veterans Administration and a professor at the University of Washington, sat on one of the FDA’s advisory panels on the inhaler question.

Swenson recalled that environmental experts said the ozone layer would repair itself in 50 years if CFCs were eliminated. When he asked them how much longer it would take if the CFCs in asthma inhalers were exempted, he recalled the answer as “roughly another week.”

Patient advocates focused their attention on a generic relief inhaler with the active ingredient albuterol that sold for $15 or less. They warned that if the inhalers were reformulated to replace CFCs, the generic version would be banned.

Their fears were realized after the pharmaceutical industry developed a substitute propellant, HFA (hydrofluoroalkane).

The FDA concluded that it wasn’t in a position to judge how perilous inhalers were to the ozone layer. It forced the generic inhalers off the market at the end of 2008.

In a document accompanying the ruling, the agency quoted a projection from an economic consultant who had been hired by the pharmaceutical giant GlaxoSmithKline: The reformulated rescue inhaler would increase the average cost per patient by just $16 a year.

That projection turned out to be optimistic. The average annual cost per individual using the albuterol inhalers rose to $208, a $71 increase, according to government estimates. That amount includes what was paid both out of pocket and by insurers.

Nationwide, total annual expenditures on albuterol increased to $1.6 billion, up from $984 million. That’s an increase of more than 60 percent, only a small part of which can be explained by the 10 percent rise in the number of people using inhalers.

These figures are based on a comparison between the average annual expenditures for the four years leading up to the ban (2004 to 2008) and those for the four years following the ban (2009 to 2013). To account for inflation, the numbers were adjusted to 2013 dollars. (They were compiled by the Agency for Healthcare Research and Quality, a division of the Department of Health and Human Services, using the household component of its annual Medical Expenditures Panel Survey.)

The International Pharmaceutical Aerosol Consortium vehemently denies that it sought to capitalize on the ozone scare.

The International Pharmaceutical Aerosol Consortium vehemently denies that it sought to capitalize on the ozone scare.

But the actual cost of the CFC ban may be billions of dollars more. Maintenance inhalers had also relied on CFCs. The switch to the HFA propellant “put a roadblock” in the way of a generic version of maintenance inhalers, Fahy said.

“This resulted in new formulations with new patents, but it did not result in major new treatment advances for patients,” he said. “Although seven new inhaled drugs have been approved for asthma over the last five years, none of these drugs target new disease pathways in the lungs.”

Medicare alone spent $4.1 billion to cover the cost of the major brands of maintenance inhalers in 2014, the latest year for which figures are available. For the same year, Medicare spent $680 million on albuterol-based relief inhalers. And the Medicare population, largely composed of people 65 and over, accounts for only 7 percent of the 25 million Americans who suffer from asthma, according to the Centers for Disease Control and Prevention.

Prominent brands of steroid inhalers include Pulmicort, Qvar, Flovent and Asmanex. They differ in delivery systems (spray or powder) and in their formulation. However, their active ingredients are steroids that have been on the market since at least the 1970s.

Following the CFC ban, the pharmaceutical industry came under fire for capitalizing on the ozone scare.

In an email, Maureen Donahue Hardwick, legal counsel for the International Pharmaceutical Aerosol Consortium, vehemently denied this charge. “IPAC’s member companies did not [her emphasis] proactively seek a phase out of CFCs,” she wrote, “and did not view this as some sort of commercial opportunity. Rather, the companies responded to the strong global concern … on the significant negative impacts to the ozone layer caused by CFCs and other ozone-depleting substances.”

While the ban on generic albuterol inhalers generated press attention at the time, and while the news media have occasionally called attention to the problem (notably in this front-page article by Elisabeth Rosenthal in The New York Times), there has been no widespread public outcry about the high cost of inhalers — even though asthma afflicts 1 in 11 children and 1 in 12 adults.

Who makes up the rest of the cost? Well, we all do, through higher premiums and taxes.

In large part, that’s because private or public insurance picks up most of the cost, and the size of copays does not necessarily correspond to the differences in the actual cost of prescriptions.

To find out what I’d pay without insurance, I checked the prices of two common inhalers on the drug-comparison website The lowest price for a 120-dose Flovent HFA (220 mcg) inhaler, which is for maintenance use, was $337; for a 200-dose Ventolin HFA (90 mcg) inhaler, which is for immediate relief, the price was $58. (In Canada, the prices were $100 and $30, respectively.)

However, my out-of-pocket expense for each inhaler is the same: $16.67 (I buy them in bulk, at three for $50).

Who makes up the rest of the cost? Well, we all do, through higher premiums and taxes.

The soonest we may see a generic inhaler is next year, when several companies plan to come out with versions of the maintenance drug Advair. There’s no word on when albuterol, the rescue medicine, will be available again as a generic inhaler.

Producing generic versions of inhalers is much more complicated than making generic pills. Each inhaler is protected by multiple patents, which expire at different times and cover such components as the chemical formula and the delivery system. A patent lasts 20 years from the date it is filed.

Dr. Christopher Hardy Fanta, a Harvard professor who is director of Partners Asthma Center in Boston, reflected the frustration of asthma specialists interviewed for this story.

“The bee in my bonnet is that these inhaled steroids have been available since the mid to late 60s, and here we are 50 years later and there is no low-cost, generic steroid inhaler on the market,” he said. “And it seems like a crime.”

Steve Maas is a freelance journalist and former Boston Globe editor who lives in Brookline, Massachusetts.

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61 comments / Join the Discussion

    I recently was in an ER for dizziness and nausa. After laying on a stretcher for 24 hours not seeing a doctor. I was transferred to another hospital because it would be at least another 24 hours before I could get my vertigo properly diagnosed. In the hospital they gave me flovent 50 mg. Didn’t need it, I have no asthma, COPD or emphasima, bronchitis. I got home and googled flovent. The price was over $300.00 a discus! I told my pulmonologist not to prescribe anything as I have no breathing problems. Even though my insurance paid it I felt it wasn’t fair to them either. I’m doing fine on tests and don’t need anything. Doctor was pushing meds on me! There all together in this scam. Flovent is under $10.00 everywhere except the US. Big pharma donations to our elected officials’ campaigns is the cause. Greed


    Here is a coupon you can use on generic Proair and generic Ventolin, it really knocks the prices down.

    Member ID: 10 digit patient phone number

    I worked as a Pharmacy Tech, but left to start a company distributing discount cards. This coupon is the best for these inhalers.


    In Africa a Ventolin inhaler will rush you less than $10. A generic with identical make up will be around $3. What’s up with prices in the US?????


    That’s because here in the US we are complete morons, we let the drug companies get away with charging us with whatever they can Pass it along to the insurance companies which results in higher premiums if you’re lucky enough to have insurance what’s up with our politicians oh I know Sticky Fingers yeah that’s right political contributions may burn in hell for their greed
    We need one honest person in the house that is for the people and not their own clinical needs who can help spearhead lower prices for those in need why should we die because we can’t afford our medicine I saw prices for meds for cancer patients I couldn’t believe it was over $12,000 a month. We the citizens need to stand up and say we will take it any longer we want fair pricing like are a able in other countries. If they can do it there they can do it here, so where is that one honest politician who cares about the American people who cares who lives and who dies. Oh you know they got great insurance and that pays for everything We need to stand up people let your let your voice be heard. No I’m not a wacko radical and I am certainly not violent I’m just angry at our politicians for not helping there’s so many people in this country who need affordable healthcare medicine, and it’s time to give us some dignity. Politicians have incredibly great medical coverage not to say lucrative retirement benefits all I want is affordable medicine that doesn’t take my entire Social Security check for one or two meds.
    God bless America God bless you American people and God bless a politician who has the you know what to fight for us . Oh I said the G word I guess you’re going to come looking for me now I can’t talk about God it’s illegal now. I’m better now I’ve vented my Opinion


    It’s worse than is commonly noticed (I had my albuterols spike in price recently, too).

    Do you guys remember when George W Bush was in office, there was a methamphetamine epidemic? But at the same time, there started to be mass prescribing of ADD meds which are, in fact, amphetmaines (usually). Independent scientists have studied the two substances (meth amps and amps), and it has been concluded that they are the same drug. But that’s not all, you can actually get prescribed pure methamphetamine! look under your formulary!

    It is prescribed for narcolepsy (ok, fair), ADD (what?!), and…get this…OBESITY. “Let’s reward people who allow themselves to become obese with cheap drugs, or people who tell psychiatrists that they can’t concentrate, too, but if anyone competes with us, arrest them and turn them into a convicted felon!” The issue here is that people who do not have health coverage may very well have those same conditions and are trying to medicate themselves.

    When it’s illegal, however, who are they going to buy from? People that don’t care about following the law, right? so a rise in MA consumption correlates to a rise in crime, but it’s not the cause. And, they’re forced to make it with readily available hardware store chemicals, which contain impurities, so self-medicating users consume poisons along with it.

    So what happened here is the entire medical industry was brainwashed by the propaganda of twisted facts to pass laws making it legal for a few companies to produce these drugs. Any competitor will become a felon and locked into a cage like an animal. In fact, we have 5% of the population of the Earth but almost 25% of its prisoners (higher in percentage and in number than both China and Russia combined).

    Those who think we have no slaves have clearly no knowledge of our prisons. They work for pennies per hour, and they shop at the one store in prison called the Commissary.

    The Bush administration decided to make not-crimes into crimes by misleading the population, supplying them with slave labor, and, get this: those “commissaries” in Federal prisons are all owned by the Bush family!

    The crimes these people are guilty of are really “You didn’t buy MY drugs?!!”. So when you have supply coming from lawbreakers, it’s easy to portray MA as the cause of criminal activity, you get bad people involved, and you get strange chemicals mixed in – sometimes on purpose.

    NOTE: This is only vicariously related to albuterol. I wanted to expose some of the corruption at even higher levels of the medical industry and our government officials.


    Before the failed and corrupt Obamacare crap I could get my inhalers for around $20 now my insurance is over $800 a month and the inhalers have gone up to almost $1000 for the ones I use. Corey Booker and all the other big pharma politicians need to be thrown out of office!!!!!! Funny how we never see a cure for anything but only maintenance meds. The whole thing is a scam and until we get the politicians who are taking lobbyist money nothing will be done!!!




    That stupid pfc ban in my inhalers cost me. Before, with the same insurance I used to get 2 albuterols inhalers for a copay of 10$ After the BS switch I got 1 for 30$. Unbelievable! I’m going to Mexico in couple weeks to reload. What a racket these filthy pharmaceutical companies are!!



    Do you need a prescription to buy abuterol in Mexico? How much does a generic cost there?

    Also, would you know if you can buy something like Flovent ( fluticasone propionate) without a prescription as well?

    I am looking forward to your reply.


    Michael Kuhn


    You are right! About 2 years ago, I thought that my breathing was somewhat affected by the environments etc. After I saw a pulmonoligist, who ordered breathing tests, I was told I had COPD and was prescribed Albuterol Sulfate HFA 90 mcg with a counter. I use it very sparingly because I hate all chemicals and try to go natural, whenever I can. Several months ago, I thought, before going on holiday, to have a spare. First of all, the pharmacy took it upon themselves to just give me something different that cost $ 45 . They argued that what the doctor had prescribed ws not available and they just gave me the supplement. I returned it and asked for my money back. I am personally appalled about the Pharma industry and certain prices that truly sick, incurable people have to buy. I am hoping that President Trump will go after the Pharmaceutical. Somebody is going to get rich. One thing that should not allowed is, that doctors get kick-backs for meds that are expensive and that the meds companies are pushing. Any time, I get a prescription, I read the side effects and more often than not, the very prescription that is supposed to curb my problems, is actually giving me theee side effects. What is wrong with our medical profession/phamarceutical industry. There are many was, to get natural remedies from natural stuff all around us. In the case of COPD, I do very specific breathing exercises twice daily, which has helped me to be stable for several years.


    I have alot of different inhaler but I need the money for all them who buy them.


    Is there any way to restrict these truly corrupt price hikes for asthma medication? This is ridiculous and some drug company doesn’t give a c— about whether people can breathe or not just as long as their pockets are lined with the money from the suffering of us “insignificant” peons. These people should be imprisoned in an airless room.


    Wealthcare isn’t HealthCare… it only purpose is to ensures massive profit flow to the 1% corporations and their oligarch owners.


    Hello. I was diagnosed with allergic asthma a few months ago and was prescribed Flovent HFA AER 220 MCG which was costing me $131.oo for a 90 day supply through my online drug provider, Optum RX through my United Healthcare Insurance. I need to refill it and it is now going to cost $365 for a 90 day supply. I was having enough trouble paying the $131 so there is no way I can afford the $365. Does anyone have any suggestions where are how to get this at a lower cost. This is the lowest cost I can find anywhere. Thanks!


    Find a local Community Health Center, and a local Pharmacy that participates in the 340B program. Your Pro-Air and Flovent should be about $4 each


    Yes, you can get a year supply of Asthma Inhalers, for the price you pay for one Month here in the US. Our Pharmacy’s cost here is crazy and there is no reason why? I will give you there Web-Site info if you would like…My friend would have saved over $5000, if she would have known about it earlier.. Just saying..So sad our system lives to take advantage of any Drug that they know people need…enough said..,


    Save your breath and check out the Buteyko method. Many free videos and information downloads. The BIG idea? Asthma is chronic hyperventilation. Crazy? If you are mouth breathing, you are hyperventilating. Close your mouth. OR try stopping your morning meds one day and when your chest starts feeling tight, breathe into a paper bag (standard first aid for hyperventilation). I just used my cupped hands. IT WORKED!!! In the last 7 weeks I have completely stopped my maintenance meds and only used my rescue inhaler twice, when I moved the furniture, an activity that normally has me prostrate. YOU DO NOT HAVE TO SUFFER. I have invested $25 in the Buteyko information for a classier method than paper bags. That would have been $600+ worth of drugs. THOSE DRUGS CAN KILL YOU. READ THE LABELS. Freedom is better.


    I hate to break it to you but your asthma is going to kill you a lot faster than the drugs.


    I don’t believe I’m hyperventilating. In the hospital for past three days, intubated in ER, IV steroids pulse ox of 82% when the ambulance brought me in. I think you need a psychiatrist instead of a Pulmonologist


    After being poisoned by Cipro (a nightmarish ordeal that took a couple years of my life and left me with some permanent side effects) I HAD to get off of inhaled steroids, since they exacerbate the fluoroquinolone toxicity. I was barely able to walk without help, had lost 1’/3 of my body weight, was in unimaginable pain, with reduced vision and horrific olfactary nerve damage that made everything in the world asphyixiate me. So when ny naturopath (the ONLY doctor to actually help, after a dozen allopaths threw me under the bus) suggested H2O2 IVs, I said “yes.” I figured it would either help me or kill me (thanks to scare tactics from a big pharma trained dr.) Well, after 1/2 dozen IVs, I was OFF inhaled steroids and asthma free for two years. Then when i did get asthma I would just rely on the ventolin. For those who are struggling, here is a suggestion that has kept me mostly asthma free. MSM. I started at around 2,000 mg a day, and graduated up to 6,000 day. Did that for a few months, and then back down again. No asthma. And i have had asthma all my life. It is criminal the drug companies charge the most for those drugs most needed. Big pharma is the new mafia.


    Where can we order the GSK Ventolin rescue inhaler buy ordering out of the country. We used to use Canada Drug Stop but it looks like they aren’t in business any longer. My husband can’t afford to pay $48 a month Copay. He needs it regularly for COPD. I am so angry they would do this to us when we know it is really cheap to produce.


    I have had asthma all my life. Ventolin MDIs used to cost $16 to $20 back in the 80’s and 90’s. then they went up went they discovered that oh the propellants aren’t good for people, lets take it out and jack up the price, heh heh, yeah lets do that. now today, here in 2019 almost, I purchased my Ventolin MDI, just as I have every month for most of my adult life, for $53—Fifty three dollars!!! Why is this medicine still so ridiculously expensive? I haven’t even read this article yet. In my mind, there is no reason in the world why this should be so. and that was my COPAY. I feel terrible for all those old elderly COPDers out there who have to cough up (no pun intended) hundreds of dollars each month for this life saving device! Hopefully, they are opting for the waaaaay cheaper alternative and purchasing the nebulizer solution instead for a few bucks to help them breathe in and out.

    There is corruption somewhere to keep this ongoing, and it should be stopped. Whoever is responsible, is responsible for millions of people in this last decade or so and how it has affected them financially and medically. Shame shame shame on them!!!


    Fortunately, I am a pharmacist, unfortunately, I developed COPD. When I received prescriptions for treatment, my rescue inhaler – Ventolin – was $63, with Medicare and my steroid inhaler was $421. That is fine as in the initial stage of Medicare you only need to pay a copay and if you show your MD the formulary, he can choose one that is covered by your plan. However, that $500 a month is counted towards you benefits and in around 6 months you will be pushed into the “donut hole” where you are required to pay full cost for the medicine. I have solved that problem by purchasing a portable nebulizer (prices range from $75 to$200) and therefore I can use generic nebulizer solutions at a fraction of the cost. Nebulizers are less convenient and require maintenance but I’ll be damned if I let “big pharma” take advantage of me!!


    I was Dx’d with asthma in Dec 2017. Did some online research once i realized i could not afford Symbicort (sp). Thankfully I found a company that went genetic with their steroid inhaler!! Google:
    AIRDUO RESPICLICK. Generic at Wal-Mart is $80’sh!! I can do that!! NOT $385!!! It is NOT an HFA inhaler. Happy I can breathe again!!


    I went to fill my Symbicort Rx today for a 90 day supply (x3 inhalers) and was quoted $277 out of pocket–and that’s after a $600 manufacturer copay coupon. The manufacturer price was quoted at $1,240 for three inhalers, or roughly $410 a piece. Outrageous. I walked away leaving my prescription at the pharmacy and I’m now researching the process to start a class action lawsuit. This country has completely perverted the notion of health care as a for-profit industry, and the combination of manufacturers constantly hiking prices for no other reason but profit combined with insurance companies passing more and more cost along to consumers is completely unsustainable. We’re headed for a healthcare crisis in this country if something doesn’t change fast, and if our fearless leaders continue to saddle up to drug manufacturers instead of doing what they were elected to do. I’m so beyond furious at this point, time to start writing letters.


    Anyone looking for plain alubuterol inhalers can easily order them online from many Indian pharmacies for around $10 each if you order like 7 at a time. Their websites say you have to have a prescription but they don’t ever ask about this. I have used CIPLA brand inhalers from India for years and saved so much money and frustration. No Appointments, co -pays, etc. etc. just order onine, wait 10 days and it comes straight to my door.


    Please give me the name of the web site that you use. I pay over 400.00 for Adair for a month. That doesn’t include my inhaler . Thank you!


    Well, it looks like Primatene Mist HFA will be back OTC on the shelves by the end of 2018. It will probably cost twice as much for 1/2 the contents of previous cfc version but req no dr. visit. Gives some hope. Hang in there. Google “Amphastar quarterly report may 9, 2018”. Scroll down meeting transcript to read questions about PMist. God bless.


    I don’t have insurance and my mom will usually share her medicine with me. Which I’m sure you can guess might not go that well. If shes not suffocating then i do, but i don’t tell her cause i would rather her breathe than share her medicine with me. I went to mexico once and bought like 6 inhalers cause they sell the real authentic albuterol inhaler that you can buy in the U.S for 60…for only 9$ i know people might freak out and say all these things about it being mexico but… It didnt need a perscription. It was 9$ for one and worked exactly like any inhaler i could get in the U.S.


    The countdown meter on the new inhalers is because it is difficult to tell how much remains. The CFC type could be shaken and you could feel the contents splashing around and gauge how much was left. The HFA type feel like they are foamy inside and you can’t feel much of anything when you shake it. It have taken to using a gram scale to measure the weight.

    And there is another problem. The HFA “puff” is not as distinct as with the CFC. In fact it is so weak that often I think it has misfired. Misfiring was a problem with the CFC type but you could easily tell when it did. But with the HFA it’s difficult to tell plus I have proved that it does misfire often. I find myself puffing again then puffing into the air to watch it to see if it really worked then puffing yet again. The end result is I wanted one puff but the misfire caused me to fire it 3 or 4 times. Most of the medication wasted into the air.

    I paid 7$ per canister in 2000 for CFC type. Today I pay $70 per canister for HFA type.


    The patents for Albuterol HFA were effective January 2008. So expect generic inhalers in January 2028 at the earliest. Interestingly in most countries including India, the government denied non generic status when CFC to HFA propellant were introduced. So Glaxo Smith Kline sells Ventolin in the US for $300+ and in India GSK sells it for $1.50 (Rs. 100 to be precise). I have been buying my annual stock each time I visit India and it is available over the counter. So if you do head there (or know any Indian colleague/friend) feel free to buy a year’s supply from India. Outside the US Albuterol goes as Salubutamol. I personally refuse to pay $25 co-pay for this. If yo


    I am getting over the flu and my doctor prescribed a Flovent inhaler for my asthma. My insurance doesn’t cover ANY steroid inhalers (Secure Horizons/United Healthcare for seniors). One inhaler would cost me $300.00 I used to get these for a simple copay. I can’t afford one, not to mention a maintenance RX for 3 months. I don’t have that kind of money on Social Security. It’s criminal.


    I just returned from a mission trip in Africa last year and while I was there, I contracted pneumonia. I later had residual asthma and I purchased Ventolin CFC free inhalers for almost nothing. The price for a smaller inhaler was $3.31 and the price for a larger one was $4.41.

    In terms of my medical history, I had difficulties breathing once in my 20s and I was able to swing by my local grocery store to buy Primatene Mist. As others have noted, it was very effective and affordable and it lasted all year.

    When I returned to the US in October of 2017, I was
    disgusted to find that Primatene was not available over the counter or elsewhere. I was disgusted to find that CFC free inhalers were not available over the counter (as I purchased them easily and in Africa). Lastly, I was disgusted to find that there were no affordable options at all.

    As I returned to the US, I did not have insurance so I had to pay $60 for a virtual doctor visit and prescription. last night, I paid $80 for the Proair HFA inhaler at Walgreens.


    And no, the inhalers aren’t made with rocks and sticks. The inhalers are of the same quality that you would buy anywhere else.

    My father in law died on Christmas Day after a 2 year struggle with COPD. I watched him die using Proair, which took no effect during his last asthma attack.

    As a child, I didn’t understand why older adults complained about government corruption. As long as I had my pizza, I cream, and Roller Blades everything seemed fine to me.

    I now vividly see what’s been going on and I will die fighting it.

    I plan to organize and hire attorneys to start looking into legal remedies. There is no excuse under the sun as to why the poor can not have access to life saving medications that should literally cost $1 in the US.

    If anyone wants to start shaking things up please respond and we’ll exchange information. If not, you’ll see my name in other threads out there. With help from on high, I seek to scatter these wicked politicians, and big wigs in pharma.

    I’m in Colorado, where everyone is high on weed but the weed smoke is some how good for the Ozone? The next time they make a ridiculous claim about damage to the Ozone, we need to tell them to bring a piece of it down here so we can examie it. If we can’t observe it, than their statements are pseudoscience, sorcery and trickery to manipulate the markets and the masses.

    Pro 28:1 The wicked flee when no man pursueth: but the righteous are bold as a lion.


    Big pharma is so friggin greedy with the ban on CFC based inhalers the people that did the research stated banning all CFC’s it would take 50 years for the hole in the ozone later to close when asked how long it would close if CFC inhalers were exempt from the ban it was only an extra friggin week so they were going to exempt the inhalers but Big Pharma saw the oppurtunity to make people pay only for name brand meds due to all the patents they could put in place making a HFC inhaler so they fought the exemption and won and all the generics webt away it is sickening and dangerous I have insurance and my co pay is $50 it is ridiculous.


    Finding your post tonight is crazy off the charts synchronicity. I share your concerns wholeheartedly. I suffer terribly from asthma and the Primitine being removed due to “ozone’ treaty is so ridiculous and given the human suffering by asthmatics. I would love to connect. I am at the point too where I am ready to move on this matter, and this being a long time coming. I have some great ideas in mind. Perhaps we can talk. Give me a shout.


    When I had Blue Cross you got your prescriptions through Express Scripts. I paid very little for proair hfa. I retired and have my prescription insurance through SilverScript. They won’t pay for it. Its not covered. They also won’t pay for one of my other prescriptions. I wish I could go back with Express Scripts but don’t know a supplement insurance that uses them.


    I am so sad that inhaler which i dont think is harmful to anything should be only accessed to via prescriptions from doctors and for those who dont have health insurance so we should just die. i spend $50 a month to buy inhaler on the black market to stay alive. this crazy.


    Me too Randy. It sucks, plus with out insurance you’ve got to pay for a doctor’s visit just to get the prescription too! It’s B’S. Yeah if we want to overdose on heroin that rescue medicine is free


    Besides the expense of Flovent which is outrageous, I have had another problem that I would love an answer to. The mechanism frequently gives me less than a full dose. My pharmacist told me to run the holder under water. That would work a few times, and then I couldn’t get anything. Glaxo Smith Klein told me that was wrong and refused to replace the inhalers that I had trouble with which was every single one after what they said was a three inhaler replacement life time limit. I read the information sheet very carefully and am doing everything exactly as they say to. My next inhaler continues to have the problem. After two puffs it took five more to get anything. And that seems to be a pattern. I’m at my wits end and would appreciate any advice other than use a spacer since I already do that correctly.


    Look at the “business” end of the inhaler whee the material actually comes out. I have had occasions where the nozzle in Flovent inhalers got clogged. The discharge nozzle had a visible white deposit in/over it. Here’s how to clean it:

    Take the medication “bottle” out and run the inhaler under hot water for a while, especially the nozzle. Blow through the inhaler to help remove the water afterwards. Wait until the inhaler is thoroughly completely dry. Put the medication bottle back in; press into the nozzle. If clogging was the problem, this should fix it.


    Just a little background: I finished a Pediatric residency in 1970 after a rotating internship, some surgery, ER coverage, delivered 70+ babies. Then out of necessity ended up with more adult care than peds. Now retired Navy, where most docs, depending on their duty station, end up taking care of adults and children. Now working in Urgent Care seeing more adults than children.
    I practiced before we had Albuterol or ICS (Inhaled Corticosteroids). Those two revolutionized the treatment of asthma. Inhaled meds for asthma effective at a very low dose because of going straight to the tissues in need. Systemic steroids, for instance, are diluted by blood volume, then saturate other tissues and organs before entering the lungs. However, I am seeing asthmatics improperly diagnosed and treated. Some MD’s will improperly diagnose bronchitis multiple times before asthma is recognized. Patients with known asthma are not instructed about management and use of controllers (mainly the ICS). Asthmatics come in to Urgent Care Clinics with exacerbation and get treated with albuterol and systemic steroids (shot or pills). They should be instructed that if control poor or sx’s prolonged, the next step is the ICS, which may bring them under control, which will prevent their seeing a doctor or getting inappropriate systemic steroids. BTY, LABA/Steroid combinations being used inappropriately, even by pulmonologists (read the black box warnings) – that includes Advair, Dulara, Breo, Symbacort.
    The Steve Maas article is great, and the information essential, very important, and frankly shocking.
    The problem: The medical profession – all up and down the chain of responsibility: individual doctors, local and State Medical Societies, and the AMA (worthless bunch) – all enablers who do nothing to oppose or correct these corruptions by both government and pharmaceutical industry. Doctors for a half century have eschewed unions because they feel doctors and medical providers shouldn’t strike. But, that is really not what most unions do – they pay off legislators. Of course, the first strategy of a union ought to be presenting their case for reform to the voters who will then demand action from their legislators. However, it is more effective and less time consuming to just pay them off – through lobbyists or campaign contributions.
    Bottom line: we are all enablers.
    K street is where legislators go from being bribe takers to being bribe givers. To often legislators retire being filthy rich – follow the money! EARMARKS? That is when legislators buy each others votes using taxpayer money. The SWAMP is deeper and uglier than any of us can imagine.


    The FDA and their fake medicine should be abolished. Asthma is a tremendous part of healthcare costs and if epi was still available OTC the costs would drop dramatically, but once again government sticks its grubby little mitts into it and makes a total mess and now all we have is deadly toxic albuterol.


    I use to use primatene mist. It was cheap and lasted for over a year. I think it was 9 bucks or so. My asthma came back as an adult. When I checked on primatene mist it’s no longer available. Albuterol and steroid inhaler was outrageous. My insurance would cover some but 90 dollars out of pocket each month for medicines that were around 50 years? I didn’t buy it. I refuse to have my insurance pay big pharma. I plan to lose some weight and exercise again. Maybe that will help. I just found out my ex wife is taking humira. That drug is over 4000 a month! She doesn’t have that kind of money. Our healthcare is bankrupting america. It’s not that we are sicker it the drug companies robbing us. Look at the commercials. Then they go see doctors and try to have them recommend their products. Capitalism is ok so long as it’s ethical. Robbing patients and insurance companies maybe legal but it’s not ethical. I hope their is a special place in hell for the lawyers, big pharma, and other leeches that are Robbing the middle class


    This was very interesting about asthma inhalers. I never have put that much thought into them before. But they are important! I currently don’t have asthma and I hope that I don’t have to encounter it too much in my life.


    Great article. But there’s yet another problem — in my experience the reformulated inhalers are not as effective as the old ones. I noticed that first when I tried using an albuterol rescue inhaler and did not find the quick easing of airway constriction that I had felt with the old ones. Fortunately my problems were not acute, but it made me wary. It may be that the new inhalers are harder to use; the instructions seem far more complex. Or it may be that they somehow affect the distribution of the active agent.

    Don’t expect much from Advair. I tried Advair Discus several years ago, at my doctor’s suggestion, and found it completely ineffective. It gives no tactile sense of effectiveness.


    Hello, good article. I agree this issue has criminal implications. My son has asthma, while I have bronchitis. Our medical inhalers are slightly different; however the expense is high on both accounts. We can’t afford to breathe. Even if we should be part of the economic elite, the cost is criminally high. Plus, the idea that others have the power to control our rights to life, is oppression.


    You are so right about the new inhalers not working as well as the old ones. I’ve found the same sentiment on other sites. I no longer have insurance but get my inhalers through GoodRx. Walmart charges me $65. It doesn’t last as long and takes 2-3 puffs sometimes. I have to use it daily. I’ve seen many online pharmacies in Canada that have the old types I used to use for much less, $21-$35 depending how many you buy. I don’t have the guts to try buying through them but it won’t be long until I have to do something.


    I have no insurance and have been sourcing my albuterol (Salbutamol) from outside the U.S. I have to use it 3-4 times a day. At 4 inhalations a day, that’s around 7 inhalers a year = $375. I’m curently using GSK Ventolin that I can get for less than $20 an inhaler. While they are not as fancy as the ProAir , no countdown meter on the back, they do their job. If you have yet to find a supplier I have been wanting to start an asthma buyers club. I have access to several generic brand inhalers, including Advair and Flovent for less than $50. You can email me at


    Why does albuterol need to be metered? Besides making it cost more?? $80 vs $20 if you shop well. Drop canister in glass of water. If it sinks; it’s full. Half way down and it’s half empty. Floats on its side; dig out a new one.
    I am amazed at how many people have no idea how to use inhalers correctly. Not only do they not get the medical relief; pharm makes more $$$$. As a nurse, I have taught numerous patients and random people in public places. Many of these people have been using them incorrectly for years and are astonished by the improved benefits. One man later told me that he went from 3 inhalers a month down to one a month and felt better. He was squinting 2 puffs at once into an open mouth which was useless


    I was under the impression there is no generic Flovent. I have been a asthmatic my whole life and now at 23 am having more trouble than ever . I have been stuck with no health insurance having too go too my local health clinic too receive prescriptions for albuterol . With absolutely no way too receive flovent i have used a full 200 puffs of albuterol in 1 week having no other option. Now that i received health insurance from a job i can barely do with my condition flovent will cost me around $280. I don’t quite understand how they think people can afford too survive if you can’t breathe you can’t work and if you can’t consistently work you can’t have health insurance and even if you do it is still too expensive too afford the preventives . Any type of help or input would be greatly appreciated because i am slightly less educated than the people i am seeing on here.


    Advair shouldn’t leave any tactile sense of effectiveness, as it’s a long term medicine, like Vanceril. It is meant for regular, long term use, and shouldn’t be used as a rescue inhaler. I’ve been taking medication steadily since the late 80’s. First it was a Proventil/Intal/Vanceril concoction, then Proventil and Intal were replaced with Serevent, and finally, the whole cocktail was swapped out for the Advair, which manages my symptoms quite well for the 12 hours its supposed to.

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