Got Asthma? Inhale This!

Is It Just Me, or are we faced with yet another medical "gotcha?"


Specifically, I'm referring to asthma inhalers. After suffering endless bouts with bronchitis and asthma throughout my growing-up years, finally I found something I considered to be nothing short of a miracle: Spray "rescue" inhalers like Primatine Mist that contained epinephrine. In recent years, generic brands have come on the market, like CVS. The cost was quite manageable; the most I ever paid for an entire new device was about $23, and refills were even less expensive. I always had two - one to carry in my purse and another for in the house.


Color those days gone. As of Dec. 31, 2011, these inhalers were banned from sale to American consumers. The reason? Because they use chlorofluorocarbons (commonly called CFCs), as a propellant. That, it seems, violates an international agreement requiring phase-out of all products that can damage the Earth's ozone layer.


This edict comes despite the fact that it's really, really hard to imagine how the CFCs in these inhalers -- even if every person on earth who owned one took a squirt at the same time -- could do serious damage. In fact, the spray is held close to the mouth and inhaled as it comes out, so my guess is virtually all those CFCs are going into our bodies, not floating up to the ozone (but apparently no one seems to care that it might damage people).


My real beef, though, isn't with that; it's what consumers who need inhalers are now forced to use -- the first of which is that it's albuterol, not ephinephrine. I'll admit I was skeptical at first, but I'd be the first to say that while albuterol doesn't work as quickly or effectively, it's a satisfactory substitute. But the second is far more egregious: There are no generics, and all available options require a doctor's prescription.


Oh well, I said -- my insurance covers all of the inhaler brands now on the market, so by the time I paid the $15 co-pay for a doctor's visit (a "regular" one anyway, so I'd have to pay it whether or not I got a prescription for an inhaler), and the usual $10 co-pay still would put the cost close to those old OTC inhalers.


Could I have been more wrong? Imagine my astonishment when I learned the cost to me for a single inhaler -- for those with insurance -- is slightly over $40! To add insult to injury, insurance covers only a limited number of inhalers each year (much as dental insurance covers cleaning only twice a year, so if you need a third, it comes out of your own pocket even if the dentist orders it).


But wait, there's more. I'm lucky (so far) in that my use of an inhaler is very intermittant, except perhaps in especially bothersome allergy seasons like fall or when I visit friends and relatives who have cats and dogs. Each inhaler contains exactly 200 metered puffs, and the doctor-ordered amount (if needed) is two puffs three times a day. I'm lousy at math, but if I used it to that full extent, a single inhaler would last about a month. Since the insurance will pay for only about four a year, making up the other eight would be more than a bit costly. 


Quite honestly, unless my symptoms get much worse, we won't have to eat Ramen noodles every night for a month to save up for my inhalers. But it's hard to imagine that all the folks who need inhalers have insurance, meaning they must pay not only for a doctor's visit but the entire cost of the inhaler. And based on the limited refills for those who do have insurance, anyone who needs an inhaler much more often than I do is out of luck as well.


It's nothing short of highway robbery and yet another consumer health-care rip-off. Or Is It Just Me?