Bernie Sanders, Senate Democrats open investigation into price of asthma inhalers

By Meg Tirrell, CNN

(CNN) — Senators on the Health, Education, Labor and Pensions committee said Monday that they’ve started an investigation into the price of widely used asthma inhalers made by four pharmaceutical companies, seeking information about practices that they say may have reduced competition and kept costs artificially high.

Independent Sen. Bernie Sanders, who chairs the committee, as well as Democratic Sens. Tammy Baldwin, Ben Ray Lujan and Edward Markey, sent letters to the chief executives of AstraZeneca, Boehringer Ingelheim, GSK and Teva about their pricing and other business practices. They requested the information by January 22.

“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 said in a news release. “The United States cannot continue to pay, by far, the highest prices in the world for prescription drugs.”

Sanders said GSK has charged $319 for its Advair HFA product in the US, compared with $26 in the United Kingdom; that Teva charged $286 for its QVAR RediHaler in the US versus $9 in Germany; and that Boehringer Ingelheim priced Combivent Respimat at $489 in the US and $7 in France. In the letter to AstraZeneca CEO Pascal Soriot, the senators said the company sells its devices for as much as $640 a month in the US, as much as 10 times what it charges in other countries.

A GSK spokesperson told CNN by email that the company “will work with the HELP Committee to address its concerns,” saying “GSK has been a decades-long leader in bringing innovation to respiratory medicine underpinned by a fair and robust patent system. We continue to be committed to making our products broadly accessible to the patients who need them.”

Boehringer Ingelheim said it’s “committed to advancing the discussion on substantive policy reforms that are needed to benefit patients with respiratory illness” and noted that these products are “more costly and complicated to manufacture” than pills made by generics companies. The company said that, “contrary to what is presented in the (HELP) Committee’s letter,” it provides discounts and rebates of 70% off the list price of its inhaler products to insurers and others that “rarely get passed along to the patient.”

The other two companies didn’t immediately comment on the letters in response to CNN’s inquiries.

In addition to the price differences themselves, the senators argued that the companies extended monopolies on their products inappropriately, obtaining additional patents close to the end of their period of market exclusivity; shifting patients to newer versions of inhalers with longer patent protection; and entering into agreements with generic manufacturers to stave off competition.

“The costs of inhalers in the US are now recognized as a significant public health concern,” Dr. William Feldman of Brigham and Women’s Hospital and Harvard Medical School wrote with colleagues in the journal Health Affairs in June 2022, citing many of those barriers to generic competition.

More than 20 million people in the US have asthma, according to the Asthma and Allergy Foundation of America, and many rely on inhalers to help them breathe. The senators cited stories of patients having to ration their inhaler use because of the price.

Pricing complexities also led to one of the most popular inhalers, GSK’s Flovent, being discontinued last week. A legal change included in the 2021 American Rescue Plan Act took effect January 1 that removed a cap on the amount of rebates drug manufacturers are required to pay Medicaid because of historical price increases; because GSK raised Flovent’s price significantly over the years, experts including Feldman explained, the company would have owed Medicaid larger penalties.

GSK introduced “authorized generic” versions of Flovent in the preceding years and discontinued the branded versions January 1. The authorized generic version didn’t have the price history that would have incurred such large Medicaid rebates, but some major insurers aren’t covering it either – probably because GSK isn’t providing large rebates to obtain better coverage as it may have done with the branded version, Feldman said.

Experts also pointed out that there are no other generic versions of Flovent approved by the FDA.

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