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The Cost of Greening the Un-and-Under-Insured

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As of December 31, 2008, albuterol inhalers (used to open airways during an asthma attack) will be going green. The medication remains the same, but the propellant will be changing from chlorofluorocarbons (CFCs) to hydrofluoroalkane (HFA). HFA is more eco-friendly and won’t damage the ozone layer as CFCs do. [Yahoo News] This is great news, right? And all of us with asthma should be applauding that from December 31 on when we move to save our own lives we’ll also be saving the planet. So where’s the problem? The new inhalers can cost anywhere from $30-$60 as opposed to the $5-$10 we’re used to paying. And for some of us that extra money is going to mean the difference between life and death.

In the United States, more than 22 million people have asthma, and nearly 6 million of them are children. Asthma is a chronic lung disease that causes wheezing, chest tightness, shortness of breath, and coughing. The symptoms can be mild, triggered only occasionally and easily treated by a rescue inhaler, or they can be severe requiring emergency treatment and possibly resulting in death. Untreated, the symptoms will worsen, and the chance of death increases. [National Institutes of Health]

There are three major albuterol rescue inhalers: GlaxoSmithKline’s Ventolin HFA, Schering Plough’s Proventil HFA, and Teva Specialty Pharmaceuticals’ ProAir HFA. A quick call to my local Massachusetts CVS prices them at $42.49, $48.49, and $44.59, respectively, and a quicker call to my prescription insurance company prices my copays at $16.46, $11.46, and $11.14. I’ll be okay, so will anyone else with comparable insurance.

But, according to the Centers for Disease Control, 43.1 million Americans of all ages were uninsured in 2007 (that’s 14.5 percent of the population). Those uninsured include 8.9 percent of children under age 18. [CDC] Are we really expecting them to be able to pay $43-$49 for an inhaler that they may only need to use once every three or so months, even if it could be a matter of life or death?

They’d be stupid not to, right? I always have a few inhalers hanging around in the various bags I use, left at work, in my car. I can afford to do that. But what about the people who are being asked to choose between paying their mortgage, heating their home, buying food, or buying an inhaler they may or may not need? They need the first three right now, those are the priority, the maybes come later, even if those maybes might endanger someone’s health.

The albuterol inhaler manufacturers are doing a bit to help. GlaxoSmithKline is offering a $15 dollar coupon for your next prescription of the their Ventolin HFA, offer is limited to 4 prescription refills per year. Schering Plough has a transition kit, offering One free Proventil HFA inhaler, and up to $15 each off your next two Proventil HFA prescriptions. And Teva Specialty Pharmaceuticals has the ProAir HFA Patient Discount Card that entitles you to up to $20 off each of your next 5 ProAir HFA prescriptions. (Check all offers to see if you qualify.) This is great, but it still leaves $28, $34, or $25 to be paid out of pocket, and that can be a lot of money to someone facing financial difficulties.

It seems I spend a great deal of my time talking about how in society’s rush to improve and be better (safer, greener) we lose sight of the people involved and how we might be harming them. We’re doing it again. In our quest to make asthma rescue inhalers better for the environment we’re ignoring how dangerous asthma can be and how difficult it is going to be for the un-or-under-insured to purchase the new, green, rescue inhalers.

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Written by tldegray

December 5, 2008 at 12:37 am

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