Are inhalers the Senate HELP Committee’s next crusade?

Find a good reason for an inhaler to cost $7 in France—and $489 in the US. You can’t. At least, that’s the wager four members of the Senate Committee on Health, Education, Labor, and Pensions (HELP) made on Monday when they opened an investigation into four pharmaceutical companies for alleged price manipulation.

Senators Bernie Sanders, Tammy Baldwin, Ed Markey, and Ben Ray Luján sent letters to AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline (GSK), and Teva soliciting an array of internal documents, such as financial statements, patent information, and evidence of financial assistance offered to patients.

The probes seek to corroborate what the senators already suspect: Inhaler manufacturers are price gouging.

“I am conducting an investigation into the efforts of these companies to pump up their profits by artificially inflating and manipulating the price of asthma inhalers that have been on the market for decades,” Sanders, who chairs the HELP committee, said in a written statement. “The United States cannot continue to pay, by far, the highest prices in the world for prescription drugs.”

Because asthma is so widespread in the US—where around 25 million people have the condition—the price pain is likely felt by many.

In a statement, Boehringer Ingelheim claimed that—contrary to the contents of the committee’s letter—it offers “discounts and rebates of 70% off the list price of our inhaler products to insurers, pharmacy benefits managers, and other parties. Unfortunately, these discounts rarely get passed along to the patient.”

A spokesperson for GSK told Healthcare Brew that the company “will work with the HELP Committee to address its concerns.” Neither AstraZeneca nor Teva returned requests for comment.

In Canada, the price of a generic equivalent of the AstraZeneca Breztri Aerosphere inhaler retails for less than $100. But just across the border in the US, where no generic equivalent is available, patients must pay more than six times that cost for the Breztri if they lack insurance coverage.

A central reason for the price difference is patent laws in the United States. Domestically, drug companies have been able to hold—and maintain—decades-old inhaler patents. Thus, no generic drug market is able to develop and compete, keeping costs high.

Probing pharmaceutical patents is a great start, Kenneth Mendez, president and CEO of not-for-profit Asthma and Allergy Foundation of America (AAFA), told Healthcare Brew. Yet he said it’s no panacea.

“Because the system is so complicated, it’s really hard to pin it on one specific piece,” he said. “But the patent is one part of that.”

Other variables of drug-pricing arithmetic include pharmacy benefit managers, insurers, employers, and regulators.

Under the current system, about 3,500 US adults die annually from asthma-related illnesses, per the Centers for Disease Control and Prevention (CDC). It’s also a health equity issue: The CDC found that Black people in the US are 2–3x more likely to die from asthma than any other racial or ethnic group.

According to a 2017 survey conducted by the AAFA, the top three reasons asthmatic respondents missed treatment were cost related.

“People don’t need to die from asthma,” Mendez said. “With proper treatment, asthma can be controlled. There’s no reason for 10 people to die each day. The cost of treatment can be a significant barrier.”

Yet if the HELP Committee’s past crusades are any indication, that may change.

Over the past year, the committee has hounded insulin producers as part of a wave of regulation and legislation to lower diabetes treatments, with apparent success.

Last March, insulin producer Eli Lilly dropped prices for the drug by 70%. As the committee chair, Sanders appealed to another pharmaceutical company, Novo Nordisk, to do the same. Two weeks later, it announced a similar price slash.

“We appreciate that asthma medicines are now being discussed,” Mendez said.