A steep increase in the price of inhalers used to control asthma is making allergy season especially hard for some Atlantans – and even sending some children to the hospital.
“Our hospitals in Atlanta have been packed with kids experiencing asthma flare ups,” Benjamin T. Kopp, a pediatrician with Children’s Healthcare of Atlanta, told The Atlanta Journal-Constitution. “This is happening because insurance companies are not approving appropriate inhalers for kids.”
For asthma patients in metro Atlanta, the drug shortage may combine with springtime pollen and summer air pollution levels to create a triple whammy. On Monday, Atlanta’s pollen count was the highest of the year at 1345, according to Atlanta Allergy & Asthma.
Asthma is treated with two kinds of inhalers, known as “relievers” and “controllers,” according to the NIH. Reliever inhalers can be used a few times a week, or during an asthma attack. Controllers, or preventive inhalers, treat inflammation in the lungs and reduce asthma symptoms to prevent future attacks.
Doctors and patients told the AJC that a jump in the prices of controllers, and difficulties getting insurance companies to cover the cost, means that people are going without the drugs and seeking much more expensive care in emergency rooms and doctors’ offices when they have a flare up.
“I know for a fact that people are making do with nebulizers and rescue inhalers – and the emergency room,” Porscha R. Watts, an Atlanta mom living with asthma and a member of Mothers and Others for Clean Air, told the AJC. Nebulizers help to control symptoms by sending a mist through a mask or mouthpiece. She says she can cover the cost of both types of inhalers for herself and her two kids, who also have asthma. But other families she knows and has worked with in medical settings are forgoing the drugs because of the cost.
“There are controller inhalers that can cost upwards of $250 for a single inhaler,” she said. “With insurance we were paying $60 per controller — and I have very good commercial insurance. But it’s pricey for us, because insurance companies require you to buy three inhalers at a time per prescription. For a lot of families, it’s simply unaffordable.”
Kopp said low-income patients do not have access to appropriate preventative inhalers right now. “In other situations, inhalers for adults are being recommended for children, who might not be able to inhale as deeply as adults. You can’t use breath-activated inhalers for kids.”
AstraZeneca announced Monday that it would cap out-of-pocket costs at $35 per month for its inhalers for asthma or chronic obstructive pulmonary disease, starting on June 1. The announcement followed a Jan. 8 investigation by the Senate Health, Education, Labor and Pensions Committee asking why Americans pay the highest prices in the world for inhalers. Committee chairman Sen. Bernie Sanders (I-Vermont) is urging other manufacturers to follow suit.
Part of the affordability problem can be linked to GlaxoSmithKline’s (GSK) discontinuation in January of Flovent, a popular inhaler classified as both an asthma controller and reliever. The company reiterated in a Jan. 9 statement that it would begin selling Flovent as a generic drug. But insurance companies have not yet begun to cover the cost of the generic. In a March 4 letter to GSK, Senator Elizabeth Warren (D-Mass.) said the company had made the “go-to inhaler for children” inaccessible by charging more for the generic drug than for the name-brand version.
Ana Santos Rutschman, professor of health law at Villanova University, said the Flovent controversy stems from the fact that GSK’s generic Flovent is still made by GSK, and classified as an “authorized generic.”
“GSK discontinued the brand drug earlier this year, and is allowing Prasco to distribute the generic version,” Rutschman told the AJC in an email. “In other words, it’s GSK’s own generic, as opposed to a competitor’s.” Rutschman said Prasco Laboratories negotiated with pharmacy benefit managers (PBMs) — companies that administer prescription drug insurance benefits — and “PBMs decided that it was a better deal to cover another brand-name drug over the authorized generic.”
Kopp said metro doctors like himself are struggling to find treatment regimens that work. “We’ve been having to do a lot of extra work to get patients something that covers their needs. If we had access to fluticasone, we wouldn’t have these issues.”
David Tanner, medical director and doctor at Atlanta Allergy & Asthma, said non-generic Flovent’s removal from the market has had an impact on patients.
“This is the time of year when people are being forced to change from one inhaler to another, and that creates havoc,” Tanner told the AJC. “There’s a generic, but a lot of the insurers don’t have it on their formulary.”
The fact that metro Atlanta has one of the highest pollen levels in the continental U.S. has made the drug cost dilemma especially problematic for asthma sufferers, Jeremy Sarnat, an environmental health professor at Emory University, told the AJC.
“In Atlanta specifically, we are concerned with ozone — and we are right about to get into ozone season — and particulate matter, including pollen and many other sources,” Sarnat said.
According to the Environmental Protection Agency, particulate pollution is made up of tiny particles of solids or liquids so small they can be inhaled deep into the lungs and enter the bloodstream, potentially causing health problems. They make asthma worse for the 7.7% of Americans who suffer from the condition. In Georgia, 9.4% of the population has asthma, according to the CDC.
A study released in February by researchers at Emory University found that Atlanta children who live near railroads and heavily trafficked roadways may suffer from “a longer duration of asthma, greater historical, asthma-related healthcare utilization, poorer asthma symptom control and quality of life, and more impaired lung function.”
That study called for community-level interventions to address what it called “environmental injustices” that contribute to asthma in children.
Sarnat, who was not part of that study, says measures like the federal Clean Air Act have made air much cleaner in Atlanta than it was decades years ago, but motor vehicles still comprise 15-30% of Atlanta’s particulate matter pollution. Fires earlier this month in Texas and Oklahoma are bringing additional smoke pollution into Georgia.
“If we think about populations that are most susceptible to this: it’s kids, older adults and people with preexisting heart and lung diseases, like asthma,” he said.
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