Are all inhalers now $35? What Patients Need to Know About Recent Price Caps

Recent announcements from major drug manufacturers have left many patients wondering: Are all inhalers now $35? The truth is more complex, as several pharmaceutical companies have voluntarily capped the monthly out-of-pocket costs for some of their inhalers, but these programs do not apply to all products or all patients. Specifically, most patients with government-funded insurance like Medicare or Medicaid are not eligible.

Quick Summary

The $35 inhaler price caps are voluntary manufacturer programs, not a universal mandate for all brands or patients. Eligibility is limited to commercially insured or uninsured individuals for specific products, while government insurance holders must use separate assistance programs.

Key Points

• Voluntary Caps: The $35 cap is a result of voluntary programs initiated by some manufacturers (AstraZeneca, Boehringer Ingelheim, GSK), not a government mandate for all inhalers.

• Limited Eligibility: The programs primarily benefit commercially insured or uninsured patients; those with government insurance like Medicare or Medicaid are generally not eligible.

• Manufacturer Specific: Only specific inhaler brands from the participating companies are covered under the $35 cap.

• Accessing Discounts: Savings may be automatic at participating pharmacies, but some patients may need to apply for a savings card on the manufacturer's website.

• State vs. Manufacturer: Some states have their own price cap legislation, which may differ in terms of eligibility and covered products from the manufacturer programs.

• Alternative Assistance: Patients on government insurance should explore manufacturer patient assistance programs to reduce their out-of-pocket costs.

The Truth Behind the Headlines: Not All Inhalers Are Capped at $35

Headlines about a $35 price cap on asthma and COPD inhalers have raised hopes for many. However, this is not a universal rule for all inhalers or patients. The caps are part of voluntary programs by some pharmaceutical companies, with specific eligibility criteria and limitations on which medications are included.

Starting in 2024 and extending into 2025, companies like AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline (GSK) began implementing these monthly out-of-pocket cost caps. This action followed pressure regarding high U.S. drug prices compared to other countries. While beneficial for many privately insured or uninsured patients, a significant portion of the population needs to find other aid.

Who is Eligible for the $35 Price Caps?

Eligibility for these programs is based heavily on your insurance status:

• Commercially Insured: Patients with private insurance are typically eligible, and the discount may apply automatically at the pharmacy.
• Uninsured: Individuals without insurance can often qualify using a manufacturer savings card, usually found on company websites.
• Government Insurance: A major exclusion is for patients with government insurance such as Medicare, Medicaid, CHIP, or TRICARE. These individuals need to explore other patient assistance options.

Inhalers Included in the Voluntary Programs

Only specific branded inhalers from the participating manufacturers are covered. The caps do not apply to all inhalers on the market.

Here are some of the inhalers included:

• AstraZeneca (Effective June 1, 2024): AIRSUPRA®, BEVESPI AEROSPHERE®, BREZTRI AEROSPHERE®, SYMBICORT®.
• Boehringer Ingelheim (Effective June 1, 2024): Atrovent® HFA, Combivent® Respimat®, Spiriva® HandiHaler®, Spiriva® Respimat®, Stiolto® Respimat®, Striverdi® Respimat®.
• GSK (Effective by January 1, 2025): Advair Diskus®, Advair® HFA, Anoro Ellipta®, Arnuity Ellipta®, Breo Ellipta®, Incruse Ellipta®, Serevent Diskus®, Trelegy Ellipta®, Ventolin® HFA.

Manufacturer vs. State-Level Price Caps

It's important to differentiate between manufacturer programs and state laws, which can also cap inhaler prices but with different rules and coverage.

Feature	Manufacturer Programs	State Legislation
Governing Entity	Pharmaceutical Companies (voluntary)	State Government (mandated)
Eligibility	Commercially insured and uninsured (varies)	Varies by state; may not apply to self-insured plans
Covered Inhalers	Specific products from participating companies	May cover a broader range of prescription inhalers
Price Cap Example	$35/month (most programs)	Varies: $25 (MN, IL), $35 (WA), $50 (NJ)

How to Access the Discounts

Access methods vary. If you have commercial insurance, the discount might apply automatically at participating pharmacies. If not, or if you're uninsured, you'll need a manufacturer savings card, available on their websites or through resources like the Asthma and Allergy Foundation of America (AAFA).

The Bigger Picture: Improving Access to Care

While helpful, these caps don't fully address high U.S. drug costs, especially for those with government insurance. For these patients, exploring existing patient assistance programs is crucial. Advocacy continues for broader, more inclusive solutions.

Conclusion

The claim that are all inhalers now $35 is inaccurate. Voluntary price caps by major drugmakers benefit some patients with commercial insurance or no insurance and apply only to specific inhalers. Patients with government insurance must seek alternative aid. It's vital to check your specific inhaler, eligibility, and explore all available assistance programs, including state-level initiatives.

Frequently Asked Questions

Does the $35 cap apply to all inhalers?

No, the $35 cap is not universal. It only applies to specific branded inhalers from a few major manufacturers that have implemented voluntary pricing programs. Inhalers from other companies may not be included.

Am I eligible for the $35 price cap if I have Medicare or Medicaid?

No, most patients with government-funded insurance like Medicare, Medicaid, or TRICARE are not eligible for the voluntary manufacturer price caps. These patients should investigate the companies' patient assistance programs for potential savings.

Which manufacturers offer the $35 price cap programs?

As of late 2024, the primary manufacturers offering these programs are AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline (GSK). GSK's program is scheduled to be in effect by January 2025.

What should I do if my pharmacy doesn't automatically give me the discount?

If you have commercial insurance and the discount isn't applied automatically, or if you are uninsured, you may need to obtain and use a savings card. These cards can be downloaded or requested from the manufacturer's specific website for their assistance program.

What if my prescribed inhaler isn't on the list of covered products?

If your inhaler is not on the list, the manufacturer's price cap does not apply to it. You should discuss other options with your doctor or pharmacist, such as switching to an included product, or investigate alternative patient assistance programs to help with costs.

Are there any state laws affecting inhaler prices?

Yes, several states have passed their own laws to cap inhaler costs, including Minnesota, Washington, New Jersey, and Illinois. These state mandates have different price limits and eligibility rules than the voluntary manufacturer programs.

Why are inhaler prices so much higher in the U.S. compared to other countries?

Investigations into high inhaler prices have highlighted significant disparities, with U.S. prices being substantially higher than in other wealthy nations. Factors contributing to this include market practices, lack of generic competition, and the complex roles of pharmaceutical companies and pharmacy benefit managers.