Cost Remains Significant Barrier to Respiratory Care for Patients


By improving health insurance coverage and cost of inhalers, such as out-of-pocket caps, access to care can be increased. Some companies are aiming to improve access by implementing price caps.

Cost is a significant barrier to asthma care for patients, including lack of health insurance, partial coverage, and public insurance. By improving health insurance coverage and cost of inhalers, such as implementing out-of-pocket caps, access to care can be increased.1

Asthma inhaler with cartridge on wooden table | Image Credit: Africa Studio -

Image Credit: Africa Studio -

The Global Initiative for Asthma and the National Asthma Education and Prevention Program Coordinating Committee recommend a single maintenance reliever therapy (SMART), according to an article published in The Journal of Allergy and Clinical Immunology: In Practice. A combination inhaled corticosteroid ICS-formoterol inhaler can be used for both maintenance as well as quick symptom relief.2
However, a major barrier to SMART therapy could be that United States insurers typically only cover the cost of a 30-day supply for maintenance medication at a time. For SMART, the dosing might require more than 1 inhaler per month. This could be an issue for pediatric patients who may need an inhaler in multiple locations (such as school, home, childcare locations, or after-school activities). Furthermore, ICS-formoterol formulations are more expensive than albuterol, which could limit the uptake of SMART, even though it is recommended.2

Some companies are aiming to improve access by limiting out-of-pocket costs to medications. For instance, Boehringer Ingelheim has capped out-of-pocket costs at $35 per month for eligible patients who use any of its inhalers for COPD or asthma. Starting in June 2024, eligible patients can receive their inhaler at no more than $35 a month for eligible products including Atrovent HFA (ipratropium bromide HFA), Inhalation Aerosol ipratropium bromide and albuterol (Combivent Respimat), tiotropium bromide inhalation powder (Spiriva HandiHaler), 1.25 mcg and 2.5 mcg tiotropium bromide (Spiriva Respimat), tiotropium bromide and olodaterol (Stiolto Respimat), and olodaterol (Striverdi Respimat). Furthermore, the company will also continue to provide access to free products for eligible patients and decrease the list price of its medication to insurers, pharmacy benefits managers, and other involved parties.3

"The US health care system is complex and often doesn't work for patients, especially the most vulnerable," said Boehringer Ingelheim President and CEO Jean-Michel Boers, in a news release. "While we can't fix the entire system alone, we are bringing forward a solution to make it fairer. We want to do our part to help patients living with COPD or asthma who struggle to pay for their medications. This new program supports patients with predictable, affordable costs at the pharmacy counter. We will also continue to advocate for substantive policy reforms to improve the health care system."

In an article published in the Journal of Asthma, investigators assessed the cost barriers to medical care and treatment for children with asthma, determining that the barriers differed by demographics, health insurance type, and coverage continuity. In a sample of 3788 pediatric patients aged younger than 18, cost barriers to affording medication affected 7.4% and cost barriers to seeing a physician affected 6.9%. Furthermore, approximately 13.3% of Black children had cost barriers to seeing their physician compared with 3.6% of White children.1
Likewise, children who did not have insurance had higher percentages of all cost barriers compared with children who had full-year coverage. Children who had partial coverage also experienced cost barriers when affording medication with at least 1 cost barrier compared with children who had full year coverage. For children with public insurance, more children had a cost barrier to seeing a physician for asthma at 12.4% compared to children with private insurance, but there was no difference in affording medication.1

Those who were uninsured or had partial year coverage had more cost barriers to seeing a physician and affording medication compared to children who had full year coverage. Since cost is a major barrier for patients, either for those who has do not have insurance or those who are underinsured, out-of-pocket costs of therapies should be reevaluated.1

1. Pate CA, Qin X, Bailey CM, Zahran HS. Cost barriers to asthma care by health insurance type among children with asthma. J Asthma. 2020;57(10):1103-1109. doi:10.1080/02770903.2019.1640730
2. Reddel HK, Bateman ED, Schatz M, Krishnan JA, Cloutier MM. A Practical Guide to Implementing SMART in Asthma Management. J Allergy Clin Immunol Pract. 2022;10(1S):S31-S38. doi:10.1016/j.jaip.2021.10.011
3. Boehringer Ingelheim caps patient out-of-pocket costs for its inhaler portfolio at $35 per month. News release. Boehringer Ingelheim. March 7, 2024. Accessed June 5, 2024.

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