Can't Afford Asthma Inhalers

By Andrea M. Jensen CHES AE-C

3 min read

If there is one thing I do not understand, it is health insurance in the United States. How do insurance companies decide what they will cover and how much they will pay?

We are a family of 5, and 4 of us have asthma. So we have spent a LOT of money at the pharmacy over the last 2 decades.

My 3 kids are adults now, and my 2 sons have aged off of our insurance. They both pay for their own insurance...and their coverage is quite different from mine.

My middle son cannot afford his asthma inhaler

This became an issue when Middle Son texted to see if we had any Covid test kits. Immediately, I was worried because this son has severe asthma and has been in the hospital 8 times for asthma (2 ICU’s) - not to mention countless emergency room (ER) visits. When he gets sick, he gets really sick, really fast.

I asked him if he had enough puffs left on his controller inhaler, or if he needed me to pick up a refill at the pharmacy. He said that he was not taking his controller inhaler, because even after insurance, it was $400.

What?!

He said he said he had been paying $200 a month after insurance for his inhaler. He knew that he needed it, and did not want to end up back in the ER, so he paid the $200 and cut back on groceries. But he said he cannot afford to pay $400 for an inhaler.

$400. With insurance.

I am so confused, and disgusted. I do not understand health insurance in the U.S.

Why has his co-pay doubled? In the past, he could use a coupon for his inhaler. But the drug company for this inhaler no longer has coupons. He can apply for co-pay help, but who knows how long that process will take.

I had to apply for co-pay help for 7 years when Middle Son was on a pricey biologic to try to control his severe asthma. But, it takes a lot of work and a long time.

He can apply on his own for co-pay help, but that means he is not taking a controller inhaler and his lungs are suffering.

I told him to message his doctor and ask for a different inhaler. Or, he can try a federally funded clinic nearby that bases his co-pay and prescription prices on his income. He can try that clinic and I KNOW he will pay less than the $400 co-pay for his inhaler.

I will pay for his inhaler now. With a long history of ending up in the hospital with asthma and respiratory infections, I am not about to sit by and watch a train wreck.

For those of you who are wondering about coupons, many drug companies offer coupons for their inhalers and other medications. Look at the label on your inhaler and then search online for that drug company.

They should have a place on their website for coupons and/or co-pay help. It can take some time to fill out the information, but it is worth it!

My daughter cannot afford her's either, but found a coupon!

My daughter’s asthma has been acting up all summer, and her doctor prescribed a new inhaler. After insurance, it was $150. Without any nagging from me, she went on the drug company’s website and filled out the information to get a coupon.

To "apply" for a coupon, it only took her about 2 minutes, and now her co-pay is $0. Zero!

I cannot afford my asthma inhaler but still need it

Now that flu season is here, I keep an additional corticosteroid inhaler on hand. My doctor has me add that to my regular controller inhaler if I get the flu, pneumonia or Covid. That extra inhaler seems to help, and then I do not end up needing prednisone. Although I do need overnight oxygen when I get Covid.

I need this extra inhaler, but my co-pay is $200. For a generic. After insurance.

Ugh.

So, 3 of us in my family are struggling to pay for our inhalers (even though we work and have insurance.)

I am baffled. It should not be this way.

Has anyone else struggled to afford their asthma inhaler? Did you have to go without your asthma inhaler to pay for groceries or other bills?

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vicky62 Member
Honestly, the insurance companies have us under a barrel. I get letters saying that asthma medicine X is now considered a tier 3 medicine (highest rate), perhaps your doctor can prescribe Y or Z. That is just wrong. I am on a biologic in addition to my inhalers, but my insurance did not want to cover it, so thankfully I was able to qualify for their program. My old daily inhaler was over 150 a month, and when it became available at generic, it went down to 120. Sadly that one no longer works. My new one is much more expensive, and my insurance does not like paying for that one. Thankfully between having major surgery and other expenses, I have met my out-of-pocket max. I do also qualify for their discount card. I just don't get why it is so expensive, and why the insurance balks when the doctor says it is needed.
1. Andrea M. Jensen CHES AE-C Contributor
 <inline-mention username="vicky62" user-id="4197274"/> It is frustrating. Especially when the people at the insurance companies do not have a pulmonologist or allergist on their review board. So a dermatologist (or someone from another specialty) is vetoing what my specialist has prescribed? My son started on a biologic in 2007, and insurance approved it immediately. Previous to that, my son had been hospitalized 7 times. So I guess they decided it was less expensive to pay for the monthly biologic than it was for a hospital stay. We used co-pay assistance for the biologic for 7 years. I don't know what we would have done without the co-pay help! I don't understand the healthcare system either. I'm glad you found a discount care and have met your out of pocket max! Andrea, Author and Certified Asthma Educator
Cassiew Member
I have a doctor who actually considered my self pay situation. Imagine that! A doctor who cares! He gave me information for Global Pharmacy. I pay for 6 inhalers (2 a month) for 3 months for less than the price of one Flovent. Maybe your doctors would consider that for you. Its worth checking into.
1. Rebecca C Moderator & Contributor
 This is such a great suggestion, <inline-mention username="Cassiew" user-id="8576021"/>. It is really difficult for many who have no insurance or are struggling to pay bills, eat, and afford their medications. It's important to know that you can talk with the billing department in the doctor's office to see if they offer up benefits when self-paying or can't afford the medication prescribed, such as having it sent to a special pharmacy. When my daughter was very young and needed her asthma meds, we had no insurance, I was able to get the medication monthly free through the pharmaceutical company. This helped so much. Another option is those copay cards the drug company offers. They have helped so much in the past with my medications. Or ask your physician for samples. The drug companies drop them off throughout the year to help get their products prescribed. Lastly, my husband has been prescribed a medication that our insurance will not cover. He came home without it flabbergasted that he had to pay almost $2000 out of pocket. I gave him a coupon I printed out from my phone from GoodRx. He spent $24 instead. I hope this gives others hope that there are ways to get that medication you truly need. Don't give up the fight - Warmly - Rebecca (community moderator) 
2. Andrea M. Jensen CHES AE-C Contributor
 <inline-mention username="Cassiew" user-id="8576021"/> Sounds like your doctor is a keeper! So glad you were able to find someone who considers the big picture. Great tip too! Andrea, Author and Certified Asthma Educator
vicky62 Member
Honestly, the insurance companies have us under a barrel. I get letters saying that asthma medicine X is now considered a tier 3 medicine (highest rate), perhaps your doctor can prescribe Y or Z. That is just wrong. I am on a biologic in addition to my inhalers, but my insurance did not want to cover it, so thankfully I was able to qualify for their program. My old daily inhaler was over 150 a month, and when it became available at generic, it went down to 120. Sadly that one no longer works. My new one is much more expensive, and my insurance does not like paying for that one. Thankfully between having major surgery and other expenses, I have met my out-of-pocket max. I do also qualify for their discount card. I just don't get why it is so expensive, and why the insurance balks when the doctor says it is needed.
Rebecca C Moderator & Contributor
It's absolutely frustrating, <inline-mention username="vicky62" user-id="4197274"/>! I have been through this so much in the past decade. Trying one medication and it doesn't work, trying another and it's not on my approved insurance medication list, then trying another and it's thousands of dollars to obtain from the pharmacy - I truly understand the struggle. If you discover you are facing challenges with insurance coverage for your asthma treatment, it could be beneficial to have a conversation with both your healthcare provider and your insurance company. Your doctor may be able to provide additional information or advocate for the necessity of certain treatments. For example, the doctor can inform your insurance company that you've already tried X, Y and Z meds, which haven't been helpful, then maybe they will approve the one that does help - the one that's not on your medication list. Additionally, contacting your insurance company's customer service to discuss your specific situation and understand the details of your coverage may help in finding potential solutions or alternatives. Sending thoughts of healing your way and hoping everyone gets their prescribed medication. Thoughtfully, Rebecca (community moderator)

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