Experts say Medicaid rebate change is behind inhaler price cuts

“Inhalers are prime examples, like insulin, of products where manufacturers have raised list prices over very long periods of time,” said Will Feldman, a pulmonary doctor with Brigham and Women’s Hospital and an instructor at Harvard Medical School.

He pointed to Boehringer Ingelheim’s decision to drop list prices on Spiriva HandiHaler, an older inhaler that now faces generic competition, and not its newer product, Spiriva Respimat.

“That product is far less likely to be impacted by the Medicaid rebate cap policy change than Spiriva HandiHaler,” he said.

Both Boehringer Ingelheim and AstraZeneca refuted the idea that the Medicaid rebate was behind the decision to cut list prices.

“We continually look at market dynamics to assess what more we can do to address barriers to access and affordability of our medicines to help patients living with respiratory diseases lead healthier lives,” an AstraZeneca spokesperson said.

Not all the developments were positive for patients. GlaxoSmithKline in January also discontinued Flovent HFA and Flovent Diskus, two of the few inhalers approved for children. Insurance coverage for the authorized generics can vary, and the only other major alternative, Organon’s Asmanex, is now in shortage because of increased demand.

“It is the perfect storm of what is wrong with our pharmaceutical system,” Feldman said. “And the end result is patients in some cases are suffering and not getting the products they need.”

GlaxoSmithKline did not say whether the rebate was the driving factor behind its pricing changes or the decision to discontinue the two inhalers, saying it “had been planning to discontinue the branded products for some time.”

“The price reductions build on our strong track record of increasing access and improving the affordability of its medicines including an ongoing commitment to responsible pricing,” a company spokesperson said.

Capping patient copays could greatly increase access to consumers as well, even though the drugmakers already offer patient assistance programs. Kaltenboeck pointed to the ongoing access issues for insulin despite the insulin makers’ long-standing assistance programs.

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