Hixson resident Vesta Hudson has used a generic inhaler for 18 years to relieve acute asthma attacks. But come Jan. 1, a federal mandate will force her and millions of others to switch to an environmentally friendly — and more expensive — inhaler.
With no insurance through her employer, Ms. Hudson now pays $20 out-of-pocket for her generic inhaler every four to six weeks. When the last of the generics are pulled from pharmacy shelves, she’ll have scrimp to pay for the new inhalers, which are not available yet in generic form and will cost her close to $50.
“I have to have it. Something else in my life has to take a hit for that,” she said.
IF YOU USE AN INHALER
* If you still use an albuterol inhaler that contains CFCs, you will have to get a new prescription from your doctor for an HFA, or CFC-free, inhaler.
* If your doctor already has switched your prescription to a CFC-free inhaler, be sure you understand how to clean and use the inhaler, which has a softer, warmer puff than the old inhalers.
* Check the Web sites for the drug manufacturer of HFA inhalers and visit the Partnership for Prescription Drug Assistance at www.pparx.org to find discounts and coupons for the new inhalers.
WHAT IS GOING ON?
The 1987 Montreal Protocol on Substances that Deplete the Ozone Layer required the phase-out of such substances, including chlorofluorocarbons, or CFCs. The United States generally has banned the use of CFCs in consumer aerosols such as hairsprays for decades, but medicines that used CFCs were an exception.
In metered-dose inhalers, CFCs are used as a propellant to push out albuterol — which quickly relaxes and opens airways for asthma sufferers. The federal government mandated in 2005 that, effective January 2009, CFC-containing albuterol inhalers can no longer be sold or dispensed in the U.S., giving time for drug manufacturers to develop adequate alternatives.
The new inhalers, which use hydrofluoroalkane, or HFA, as a propellant are just as effective, studies show, but differ in taste, force and how the inhalers are cleaned.
Since there is not yet a generic HFA inhaler, the devices can cost three times as much as the old inhalers.
SOURCE: U.S. Food and Drug Administration, Allergy and Asthma Network Mothers of Asthmatics
www.fda.gov/cder/mdi/mdifaqs.htm
WHAT ARE THE NEW INHALERS?
CFC-free alternatives available:
* ProAir HFA (Teva)
* Proventil HFA (Schering-Plough)
* Ventolin HFA (GlaxoSmithKline)
* Xopenex HFA (Sepracor)
As of Jan. 1, millions of Americans who rely on metered-dose inhalers to treat asthma and other lung conditions such as emphysema must forgo generic albuterol inhalers. Those inhalers contain chlorofluorocarbons, or CFCs, which act as a propellant to push the medicine out in a strong, cool puff.
The new inhalers use an alternative propellant called hydrofluoroalkane, or HFA.
The shift has been in the works for years, and many already have made the switch, but asthma advocates contend many patients are unaware of the change and may face serious sticker shock at the pharmacy.
“It hasn’t been on anybody’s radar,” said Nancy Sander, president and founder of the Allergy and Asthma Network Mothers of Asthmatics, a nonprofit, membership-based advocacy group. “We have no idea how many patients have transitioned or have yet to transition. It’s all a guessing game.”
About 20 million Americans have asthma but as many as 40 million may use an albuterol inhaler to treat asthma or another lung condition, Ms. Sander said.
Patients who were accustomed to paying a $5 or $10 copay for a generic albuterol inhaler could find themselves paying up to $30 for the new inhalers, based on their insurance plans, said Dr. Marc Cromie of the Chattanooga Allergy Clinic. Those without insurance could pay closer to $50 or $60, he said.
“Most of the parents (of children with asthma) will want the child to have one inhaler at school, one at grandma’s, one in their bag. What they’re finding is these are no longer cheap, generic drugs. They are expensive, and it is becoming a cost issue,” Dr. Cromie said.
The cost increase could be a real barrier to needed medicines, particularly for the uninsured and those with high-deductible plans that require patients to pay thousands in out-of-pocket expenses before their insurance coverage kicks in, advocates said.
Some people may end up trying to limit how many inhalers they have or may ration how often they use them, potentially resulting in preventable trips to the emergency room, said Dr. Susan Raschal with Asthma Immunology and Allergy Associates in Chattanooga.
“Some people will just suffer and not use the medicine,” she said. “They can’t afford it.”
PREPARING FOR THE CHANGE
Some patients who use inhalers have even resorted to hoarding their old inhalers, which are no longer being manufactured but still can be found in some pharmacies, doctors said.
“Some people who knew it was happening actually went out and bought them all. They are just not readily available (anymore),” Dr. Cromie said. “At the busier pharmacies, most of them are already gone.”
At his Chattanooga Allergy Clinic, patient Sara Munday, of Georgetown, Tenn., said her 5-year-old son John’s asthma inhaler — Xopenex HFA — costs her a $50 copay. The drug is a tier-3 product under her BlueCross BlueShield of Tennessee insurance plan, instead of a $10 tier-1 medicine.
“It was frustrating at first to find out there’s no option for a $10 inhaler, she said. “(But) we budget for it each month.”
Advocates want the FDA to step up awareness and want the U.S. Centers for Medicare and Medicaid Services to mandate that insurers classify these at lowest tier, so copays will be as low as possible, Ms. Sander said.
“We have families who are deciding which family members are going to get to use the inhalers based on the ones that are the most sick,” Ms. Sander said. “We’re part of a mandate where we have no choice; we have to pay higher prices to breathe.”
Advocates and asthma specialists are getting the word out on coupons from drug companies that manufacture the new inhaler as well as discounts from organizations such as the Partnership for Prescription Assistance.
Despite those efforts, awareness is limited, said Shirley Cudabac, Southeast regional director for the American Lung Association. The group plans to step up some local advocacy and awareness efforts on the change, she said.
The new inhalers are just as effective as the older ones, but important differences in how to use them makes education crucial, area allergists said.
A puff from an old inhaler feels strong and cool, while the new inhalers have a softer puff and a different taste. If not warned about those differences in advance, those using an HFA inhaler for the first time could think their inhaler is not working.
“That’s going to create more anxiety, which you don’t need when you’re having trouble breathing in the first place,” Ms. Sander said.
