ShareThisBy SHELLEY SHELTON
Arizona Daily Star
Friday, June 22, 2007
Emergency asthma inhalers propelled by chlorofluorocarbons -- known as CFCs -- are going the way of the Styrofoam hamburger container.
And that means a steep increase in insurance co-payments or out-of-pocket expenses for asthma sufferers.
The U.S. Food and Drug Administration has determined that by Dec. 31, 2008, all asthma inhalers marketed in the U.S. must be propelled by hydrofluoroalkane -- HFA -- as part of an effort to reduce ozone-depleting CFCs in the atmosphere.
In anticipation of that, manufacturers have already started phasing out the CFC inhalers, shortening the length of time consumers were supposed to have to prepare for the change, said Dr. Fernando Martinez, director of the Arizona Respiratory Center at the University of Arizona.
Martinez was part of the FDA advisory committee when the administration determined two years ago that the inhalers needed to change.
"We explicitly said that our greatest concern was that there could be low-income members of the society who could not afford the expected two- to three-fold increase in price," he said.
The committee recommended a slow phase-in of the new product, he said.
Now, a year and a half before the deadline, the old inhalers are hard to find, Martinez said.
According to the American Lung Association, generic CFC inhalers cost between $5 and $25, while the new inhalers range from $30 to $60.
Though he supports the change, Martinez said he would like to see the inhaler manufacturers do more to ease the burden on low-income asthma patients.
"It's unfair that in the end, the poor have to pay for something that will benefit everybody, which is the environment," he said.
Part of the issue is that one company owns the patent on the new inhalers, said Dr. George Makol, an allergy and asthma physician in Tucson, Ariz.
Even though four companies manufacture the new inhaler, all must pay royalties to the patent holder, he said.
And there is no generic version of the new inhaler, he said.
Health insurers and makers of the new inhalers are still working to incorporate them in their co-pay plans, Makol said.
"Relatively, they're not too bad, but people are just used to getting the cheap one," he said.
The manufacturers have sent different kinds of discount cards for him to pass out to patients, he said, allowing for a free inhaler and then a discount, or free samples, or some combination, to help them make the price transition more gradually.
"We try to use them (with) patients we think would most need that," he said.
Dr. Wayne Morgan, 55, University of Arizona professor of pediatrics and physiology, has used an inhaler since medical school. He said he was a little shocked by the price increase at first, although he is able to easily pay it.
He said there's not a lot of difference in how the new inhalers work, compared with the old ones.
"You may not get as big of a blast out of it, I suppose, but the efficacy is comparable," he said. "I find personally I get as much relief from the HFA as I did with the CFC."
Some of his patients have said the new ones don't taste as good, but Morgan said that's because the old inhalers didn't really have a taste. The new inhalers have a sweet or alcohol-like taste, he said.
He did worry a bit about patients' ability to absorb the increased cost, but he sees it as an opportunity for asthma sufferers to make sure they're properly managing the disease.
"The reality is, if your asthma's managed well with the appropriate medicines, following national guidelines, you really shouldn't go through your albuterol (emergency) inhaler more than two or three times a year," he said.
People who go through an emergency inhaler every month need to talk to their doctor, he said.
