Sanders targets high price of inhalers

Analysis by Dan Diamond with research by McKenzie Beard; The Washington Post

Bernie Sanders wants to know why inhalers are so pricey

Sen. Bernie Sanders (I-Vt.) has a new target: the high price of inhalers.

The chairman of the Senate’s Health, Education, Labor and Pensions Committee is launching an investigation into the four largest manufacturers of inhalers in the United States, he told The Washington Post.

On Sunday, he sent letters to AstraZenecaBoehringer Ingelheim, GlaxoSmithKline and Teva Pharmaceuticals demanding information on the inhalers’ production, patient assistance programs and patents, including internal strategic communications. 

The letters, co-signed by Sens. Tammy Baldwin (D-Wis.), Ben Ray Luján (D-N.M.) and Ed Markey (D-Mass.), probe how the companies set prices for the tens of millions of Americans who rely on inhalers to treat their asthma, chronic obstructive pulmonary disease and other conditions, even as the companies sell the same products for a fraction of the price abroad.

“Our goal, obviously, is to put pressure on these companies to substantially lower the price of inhalers in America,” Sanders said in an interview on Friday. See the letters to AstraZenecaBoehringer IngelheimGSK and Teva.

The Vermont senator called it “totally absurd” that Teva charges $286 for an inhaler in the United States that’s sold for $9 in Germany, or that AstraZeneca charges $645 here for an inhaler sold for $49 in Britain. The four companies targeted by Sanders collectively report billions of dollars in annual revenue on the products, which are often purchased monthly. 

The companies did not immediately respond to requests for comment. Pressed about inhalers’ high prices in the past, pharmaceutical companies have cited the complexity of the U.S. health-care system, including the role of middlemen such as pharmaceutical benefit managers they say have wrongly inflated prices. (PBMs, meanwhile, have argued that they help keep patients’ costs down.)

Why the Senate HELP chair picked this fight

Pharmaceutical companies’ historic ability to set their own prices on drugs and devices has helped inflate the price of inhalers, Sanders said, and the costs are then passed along to Americans and the U.S. health-care system. He also accused the companies of exploiting loopholes in patent law, noting that the devices and drugs used for inhalers have been generally unchanged for decades.

They are manipulating the patent system, very effectively,” Sanders said. “They make tiny tweaks to their product, and they keep their exclusive patents for years and years and years, preventing generic competition.”

In the interview, Sanders also connected the pharmaceutical companies’ inhaler costs to the industry’s broader pricing practices, demanding changes.

As health committee chairman, the veteran senator has already taken a series of actions, from sending letters to holding hearings, intended to pressure the pharmaceutical industry; last summer, he released a report showing that U.S. taxpayers often pay more than residents of other countries for medical treatments developed with federal support.

“One of the reasons that we spend, by far, the highest amount of money in the world for health care … has to do with the cost of prescription drugs,” Sanders said. “I think these people are extraordinarily greedy. And … that greed has got to be taken on for the well-being of the American people.”

‘It’s a huge problem’

While politicians have spent years warning about the high cost of drugs to treat cancer, diabetes and other conditions, some public health experts say inhalers have been overlooked. About 25 million Americans suffer from asthma, and about 16 million people have COPD — and while many of those individuals rely on the devices, the high cost of inhalers can force uninsured or underinsured Americans to make trade-offs about whether to purchase them.

“It’s a huge problem,” said William Feldman, a Harvard physician and researcher who has researched the price disparities of inhalers sold in the United States and other countries. Feldman said he first grew interested in the issue as a new physician in 2015, when he prescribed inhalers to patients — and realized there were no generic inhalers available on the U.S. market at the time, forcing him to prescribe higher-cost models.

“It was shocking to me,” Feldman said.

Lawmakers are beginning to take notice. The Federal Trade Commission last fall targeted the high price of inhalers, saying officials had grown concerned that pharmaceutical companies were gaming the patent system.

“Even though inhalers have been on the market for decades, they have faced relatively limited generic competition in recent years,” FTC Chairwoman Lina Khan said in a statement, warning of potential abuse of patent rights.

Feldman noted that lawmakers have shown increased willingness to tackle the high prices of drugs and devices, referencing the long fight over the cost of insulin — a lifesaving drug for millions of Americans with diabetes. For years, insulin was subject to price hikes as pharmaceutical companies continued to patent tweaked versions of the drug, which dates to a century-old medical breakthrough. Federal regulations capping the out-of-pocket payments around insulin at $35 per month for Medicare patients took effect last week, and pharmaceutical companies followed suit and capped the price for many other patients amid government and public pressure.

“There are so many parallels with insulin, and yet this story [of inhalers] has not gotten nearly the play as insulin,” Feldman said. “I’m frankly glad that the issue of high prices of inhalers is getting some more attention.”