Patients to face costlier visits to pharmacist for inhalers

People with asthma or respiratory disorders will face costlier visits to the pharmacist after Dec. 31, and the cost might be too high for the poor and uninsured, some local health care professionals say.

By Jan. 1, patients will no longer be able to buy inhalers containing chlorofluorocarbons, or CFCs, in the United States, and pharmaceutical companies will stop manufacturing them. The newer, more environmentally friendly inhalers have a steeper price tag - about $50 to $60 compared to about $10 for the generic, older inhalers, according to local pharmacists.

No generic version of this newer inhaler is available.

The drastic price difference could cause some Rio Grande Valley patients with asthma to opt out of purchasing inhalers or seek cheaper drugs in Mexico, local doctors and health officials said.

"It really puts patients in a bind," said Paula Gomez, executive director of Brownsville Community Health Center, a federally funded clinic that primarily serves uninsured and Medicaid patients. "Physicians can prescribe it, but whether patients will get it is another story."

The U.S. Food and Drug Administration is requiring that drug manufacturers phase out CFC-based inhalers in favor of hydrofluoroalkane, or HFA-based medicines. The ingredient is necessary to propel medication into patients' lungs. The medication itself - albuterol, which opens airways during an asthma attack - is staying the same.

Research has shown that CFCs contribute to the depletion of the Earth's ozone layer.

Doctors say they've been trying to educate patients about the switch to HFA inhalers, and some patients have made the change with few problems. Private insurers cover the medication, as does Medicare and Medicaid, doctors say.

"Most of my patients have insurance, so with the people I've seen, I haven't heard complaints about cost," said Dr. Charles Austin, a McAllen family-practice physician. During the last year, Austin has switched over many of his patients with asthma to the new inhalers without much trouble.

But uninsured patients likely will have a harder time, said John Calvillo, pharmacist at Med-Aid Pharmacy in Mission.

"It's not a good situation for patients to have to absorb the (increased) cost," Calvillo said. "And there won't be a generic available for a while."

Many doctors' offices have received vouchers and coupons for the new inhalers from drug-company representatives, and those should cover the cost for a time, doctors said. But many patients who use albuterol inhalers also take several other medications, and any additional cost could be a heavy burden, said Dr. Christian Maluf, a McAllen pulmonary-disease specialist.

"We have a sick population here - it's not rare to see patients on 20 different medications," said Maluf, who primarily sees older patients on Medicare.

Maluf has educated his patients on the new inhalers, and obtains samples of the medication and coupons to defray the cost. But he doesn't just have a financial hurdle to overcome, he said.

Patients tend to dislike the HFA inhalers because the "puff" isn't as forceful as with the CFC inhalers, and it feels like they've taken less medication, Maluf said.

"They're getting the same amount of medication, but it feels different," he said. "It's very difficult to break that psychological barrier."

Maluf must tell his patients repeatedly that after December, the CFC inhalers will no longer be available, and that they have to make the switch.

"It's taken two or three attempts to convince them," he said.

Uninsured patients, however, might just opt to go without, or try to find a similar drug across the border, Gomez said. The Brownsville clinic doesn't have the money to stock the new inhalers, she said.

"I think (patients are) going to wait longer for care, and will end up in the emergency room," Gomez said.