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The Trap of Medication Cost

Once I’ve “paid off” my annual Pharmacare deductible for the year, I’m usually smooth sailing until the new fiscal year. However, this Winter, I started Spiriva, which is not covered for asthma on Manitoba Pharmacare. There’s no way to get it covered, no paperwork to get permission like exists for some other drugs, so it is either pay out of pocket or go back to Atrovent. Spiriva is giving me some of the best winter breathing I’ve had in a decade—so while I’ll return to Atrovent to save money in milder months, I’m currently shelling out the money.

The problem is, despite knowing how well Spiriva works for me after having a month worth of samples, the cognizance of cost is altering my behaviors—despite that I know better, and despite that I can afford this one drug of many.

Note that I do not recommend any of these things—speak with your doctor and/or pharmacist if you have difficulty affording your medication.

Decreasing prescribed doses

This is probably the most common trap associated with drug costs, and yes, I too, quickly fell into it. Being prescribed 2 puffs per day, I frequently find myself thinking “Well, it’s not as cold today, I’ve been feeling good, let’s just do one puff.”
While Spiriva works within an hour, it also does “build up” in your lungs for full effect over a number of weeks, as do inhaled steroids. I know I am best at the dose Dr. Smartypants prescribed, because I’ve deviated from that dose with okay-but-not-stellar results. Yet, sometimes this is not enough in my head to justify inhaling $2.

Using the inhaler past zero

Allegedly, unlike other inhalers, Spiriva claims to “lock” after the pre-set number of doses are taken. I haven’t actually found this to occur, using the inhaler past zero to save costs—sometimes long past when that little arrow points to zero in the red metered zone!.

Pondering legitimate cost management

Here in Canada, coverage often seems to be an all-or-nothing, with the exception of if you have insurance that will cover the drug minus a co-pay. As such, coupons are either non-existent or extremely hard to come by. Drug savings programs in collaboration with your insurance or provincial plan, such as InnoviCares can help with some but not all drugs.

I did contact the manufacturer of Spiriva, Boerhinger Ingelheim, here in Canada. While they suggested I contact my prescribing doctor to have them contact their representative who may be able to make arrangements, it is worth recalling that the most effective way to contact my respirologist, Dr. Smartypants, is via a fax to her office that results in them actually returning my call. Which, for a conversation like this, seems nonsensical. (Though perhaps I should try?)

Contacting your doctor for samples can also help reduce overall costs of the drug—I see my primary care doctor this week, and I am hoping that I can get some samples to stretch my supply of this medication—and my dollars.

Long-term action for reduced costs

When I encounter problems, I write not only blog posts, but letters. These letters go to my elected representatives, most notably my Member of Parliament, who has in past years proven a true advocate on issues such as medication coverage. These letters are a simple but hopefully effective way to help guide our policymakers towards change in the long-term, sharing with them issues that are important to constituents—the electorate. Elected representatives, like Members of Parliament or Congress, are the ones who can push for change including national drug coverage strategies (pharmacare), lower drug prices, and protections for those of us with pre-existing conditions.

Spiriva is one of the less-expensive drugs I am on—at $60 CAD/inhaler (at Costco), it is in my bottom 4. However, it is easy to quickly fall into the trap of cost, and it can certainly happen to all of us—even if it is merely on the principle that we should have coverage for the medications that help us which our doctors have prescribed. My doctor prescribed a drug developed for COPD but approved for asthma for my breathing—barriers of cost should not even apply. I understand the rationale for restrictions such as these but it is laughable to consider my government could know better than my doctor. The same may apply to your insurer. It’s up to us as patients to challenge this audacity in whatever ways we can to get what we need, without facing barriers of money or of policy.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • ritagg
    7 months ago

    Spiriva did wonders for me! However I also changed insurance a year ago and Spiriva was not covered. It would have cost me close to 500 dollars a month to buy, which I cannot do! My dr put me on encruse, it does ok, but not like Spiriva. I am sad about The Who,e thing. Good luck

  • Shellzoo
    7 months ago

    I love my Spiriva. I had been on Intruse Elipta but I developed a cough that kept getting worse after each use until I was having trouble talking between coughing fits and was using my Ventolin almost daily. My doctor told me I had lots of options and gave me a sample of Spiriva. Breathing better and after my evening dose I breath my best. It is a shame how high the cost gets but between my insurance and a coupon, I don’t pay anything for it.

  • Leon Lebowitz, RRT moderator
    7 months ago

    Hi Shellzoo and thanks for sharing your successful experiences using Spiriva. I imagine you must sleep well since you mentioned your breathing is best after your evening dose. That must be a good feeling for you! Keep up the good work! Leon (site moderator)

  • Lyn Harper, RRT moderator
    7 months ago

    Oh! How frustrating, ritagg. Amazing what a change in insurance can do! I’m glad you’ve found something that works (at least somewhat). It’s happened to me a few times and each time it does it’s taken quite a few months to get back to feeling like myself. I hope you find your new normal and it works for you.
    -Lyn (site moderator)

  • Leon Lebowitz, RRT moderator
    7 months ago

    Hi ritagg and thanks for your post. I will underscore the comments of my colleague, Lyn. It is always a challenge when medications are changed – especially for insurance reasons. Moving forward, let’s hope the Incruse becomes just as effective. Wishing you well, Leon (site moderator)

  • Shellzoo
    7 months ago

    That is the scary thing about the cost of medications. Patients that mean well will start to divide doses, only take if they feel symptoms or ration. This happens with insulin and blood pressure medications too. I have switched to Symbicort because paying $58 a month for Advair was taking a toll on my budget. The cost for Symbicort with my insurance is zero. I too am on Spiriva Respimat and that also costs me nothing with insurance. I feel concern for asthmatics who can’t afford their medications.

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