Central Valley

Patients gasp at cost of new inhalers

Asthma inhalers are going green. And users are seeing red over paying more for the new, environmentally friendly devices.

But like it or not, asthmatics who carry inhalers containing albuterol, a quick-acting drug that opens airways, will be switched to new inhalers soon -- if they haven't already -- that are free of chlorofluorocarbons, an ozone-depleting propellent.

The old devices -- called CFC inhalers -- will be banned for use in the United States on Dec. 31.

Pharmacists say it's increasingly difficult to order CFC inhalers. Manufacturers began phasing them out a year or two ago for inhalers that contain hydrofluoroalkane, or HFA, a more ozone-friendly propellent. The propellent forces a dose of medication out of the inhaler.

The new inhalers are as effective as the old ones, pharmacists and doctors say. But they're more expensive and operating them requires some getting used to.

Overall, prices of the new inhalers are higher because there are no generic versions, said Nancy Asai, a pharmacist at Ray Fisher Pharmacy in Fresno. And that means higher insurance co-payments for the brand-name drugs. The new inhalers typically cost from $45 to $65, Asai said.

One brand of inhaler, ProAir HFA, is available for about $30 at some discount pharmacies. But the old generic albuterol inhalers cost less than that.

The hope is prices for the new inhalers will drop in the future, Asai said.

David Harvey, 40, a Fresno radio salesman, paid about $25 for his albuterol inhaler a year ago. Today, he pays about $45 for the drug.

"Someone instituted this change," he said. "I sure as hell didn't ask for it, but I'm paying for it."

The government ban on CFC inhalers is in response to the 1987 Montreal Protocol, an international pact that called for the elimination of ozone-depleting chemicals.

The new inhalers are good for the environment, said Dr. Richard DeMera, a Fresno allergist. "We needed to do this," he said. "But patients are having to pay a higher co-pay for their inhalers."

Sonya Santellano, 30, a Fresno medical assistant, said she pays about $50 more a month for inhalers for herself, a son and stepson.

"They're pretty expensive -- but they work," she said.

But some patients complain the new inhalers become clogged and must be cleaned daily and that they don't work as well as the old ones.

"It just doesn't seem like it packs the punch the old one did," Harvey said. "I still get the instant relief, but there does seem like there's a difference."

Patients need education about the new inhalers, said Corbin Bennett, pharmacy clinical operations manager at Kaiser Permanente Medical Center in Fresno.

Kaiser pharmacists will counsel patients when they make the switch to new inhalers in September or October, Bennett said. Kaiser members will not pay more for the ozone-friendly inhalers, he said.

Dr. Malik Baz, a Fresno allergist, said the new inhalers provide the same dose of medicine. He began prescribing the new inhalers about two years ago.

He encourages patients to keep trying the ozone-friendly inhalers. Said Baz: "All the studies show they work very effectively."