In a note accompanying a set of articles on the impact of the FDA’s ban on the use of CFC propellants in metered dose inhalers and the transition to HFA inhalers, published online on May 11, 2015, the editors of JAMA Internal Medicine suggest that while any potential ecological benefits of the ban remain unclear, the benefits to the pharmaceutical industry are undeniable.
“It is clear,” they state, “that the ban has increased health care costs and improved the bottom line of pharmaceutical companies that are making hydrofluoroalkane-based inhalers. Although albuterol inhalers have been in use for more than 30 years, pharmaceutical companies have used the chlorofluorocarbon ban as an opportunity to raise the price on inhalers from approximately $13 for a generic formulation to more than $50 today.”
According to the editors, the best solution would have been for the FDA to wait until generic HFA inhalers became available before banning CFC inhalers.
The set of articles also includes a “Perspective” by a physician who recently learned about the absence of generic albuterol inhalers in the US and who blames the CFC ban for changing cheap generics into expensive brand name drugs “with no change in the medication or new research and development costs.”
Both of the opinion pieces reference the findings of Jena, et al. presented in an article published on the same day, titled “The Impact of the US Food and Drug Administration Chlorofluorocarbon Ban on Out-of-pocket Costs and Use of Albuterol Inhalers Among Individuals With Asthma.”
After reviewing US insurance data for albuterol inhaler use from January 2004 through December 2010, the authors found that the average out of pocket cost for an albuterol inhaler for patients with private insurance rose initially from $13.60 before the ban to $25 in 2008, subsequently falling to $21 in 2010.
The authors estimate a 0.92 percentage point reduction in the use of albuterol inhalers over the time period studied with no associated rise in doctor or emergency department visits and no rise in hospitalizations. They note that a significantly greater decline in albuterol inhaler usage due to increased cost is possible among patients without insurance and that the impact on those patients remains unknown.
Read the JAMA Internal Medicine Editor’s Note.
Read the JAMA Internal Medicine Perspective article.
Read the JAMA Internal Medicine research article.
