Breathing is Expensive (For Americans)

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The U.S. Centers for Disease Control and Prevention (CDC) reports that 25 million Americans suffer from asthma, and as many as 16 million suffer from chronic obstructive pulmonary disease (COPD). People with both diseases almost always require the use of inhalers, which have become prohibitively expensive for many American families. PharmacyChecker data shows that treating asthma and COPD can be made more affordable …", "dateCreated": "2022-07-12T22:51:10-04:00", "url": "/askpc/breathing-is-expensive-for-americans/", "author": { "@type": "Person", "name": "Lucia Mueller" } } } } </script> <link href="https://cdn.pharmacychecker.com/images/mobile/apple-touch-icon.png" rel="apple-touch-icon" /> <link href="https://cdn.pharmacychecker.com/images/mobile/apple-touch-icon-152x152.png" rel="apple-touch-icon" sizes="152x152" /> <link href="https://cdn.pharmacychecker.com/images/mobile/apple-touch-icon-167x167.png" rel="apple-touch-icon" sizes="167x167" /> <link href="https://cdn.pharmacychecker.com/images/mobile/apple-touch-icon-180x180.png" rel="apple-touch-icon" sizes="180x180" /> <link href="https://cdn.pharmacychecker.com/images/mobile/icon-hires.png" rel="icon" sizes="192x192" /> <link href="https://cdn.pharmacychecker.com/images/mobile/icon-normal.png" rel="icon" sizes="128x128" /> <meta name="apple-mobile-web-app-title" content="PharmacyChecker" /> <meta name="msapplication-square70x70logo" content="https://cdn.pharmacychecker.com/images/mobile/pc-tile-small.png" /> <meta name="msapplication-square150x150logo" content="https://cdn.pharmacychecker.com/images/mobile/pc-tile-medium.png" /> <meta name="msapplication-wide310x150logo" content="https://cdn.pharmacychecker.com/images/mobile/pc-tile-wide.png" /> <meta name="msapplication-square310x310logo" content="https://cdn.pharmacychecker.com/images/mobile/pc-tile-large.png" /> <meta name="msapplication-TileColor" content="#336699" /> <meta name="application-name" content="PharmacyChecker" />  <script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); 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<a href="/askpc/most-popular-recent-questions/">Ask PC</a> &lsaquo; <a href="/askpc/category/drug-prices">Drug Prices</a> &lsaquo; <span class="hide-overflow">Breathing is Expensive (For Americans)</span> </div> <div class="row"> <div class="main-panel col col-12 order-1 col-lg-8 m-auto order-lg-2"> <section class="ad-banner-horizontal askpc-internal-ad mt-0 mb-3" style="position: relative;"> <a id="askpc-internal-ad" target="_blank" href="/accredited-online-pharmacies/" data-ad-id="1" style="height: 100%; position: relative; box-shadow: 0 0 10px rgba(0,0,0,0.3)" > <img class="no-image-share" src="https://cdn.pharmacychecker.com/images/advertisements/askpc-internal-ad-1.png" height="114" width="729" /> </a> </section> <h1 id="page-title">Breathing is Expensive (For Americans)</h1> <style> .dtr-title, .dtr-details { width: 100%; } </style> <img src="https://cdn.pharmacychecker.com/images/betterasthmafatherdaughter.png"> <div class="author mt-3 mb-3"> <div class="author-image" style="background-image: url(https://cdn.pharmacychecker.com/images/Lucia_face.jpeg);"></div> <span> Written by <a class="green" href="https://www.linkedin.com/in/luciamueller/"> Lucia Mueller </a> <i class="fa fa-info-circle pharmacy-profile-tooltip green" data-toggle="tooltip" title="Lucia Mueller is the VP of Operations & Communications at PharmacyChecker. She provides readers with information regarding online pharmacies and access to affordable medication."></i> | Posted July 12, 2022 </span> </div> <div class="container"> <div class="row block-sub-nav collapsible-mobile-nav"> <a class="selection-label" href="#!" onclick="toggleSubNav(event);">Sections <i class="fa fa-caret-down"></i></a> <ul class="askpc-section-headers-list"> <li> <a onclick="go_to_section('key-findings'); return false;" href="#key-findings"> <span class="my-auto">Key Findings</span> </a> </li> <li> <a onclick="go_to_section('why-inhalers-are-so-expensive'); return false;" href="#why-inhalers-are-so-expensive"> <span class="my-auto"> Why Inhalers Are So Expensive</span> </a> </li> <li> <a onclick="go_to_section('inhaler-prices'); return false;" href="#inhaler-prices"> <span class="my-auto"> Inhaler Prices</span> </a> </li> <li> <a onclick="go_to_section('importing-inhalers-from-abroad'); return false;" href="#importing-inhalers-from-abroad"> <span class="my-auto"> Importing Inhalers From Abroad</span> </a> </li> <li> <a onclick="go_to_section('us-inhalers-manufacturing-origin'); return false;" href="#us-inhalers-manufacturing-origin"> <span class="my-auto"> U.S. Inhalers Manufacturing Origin</span> </a> </li> <li> <a onclick="go_to_section('ordering-inhalers-online'); return false;" href="#ordering-inhalers-online"> <span class="my-auto"> Ordering Inhalers Online</span> </a> </li> </ul> </div> </div> <div class="large-p"><p><span><span><span><span><span><span><span><a href="https://www.pharmacychecker.com/health/asthma/">Asthma</a> is the most common chronic condition affecting Americans young and old. The U.S. Centers for Disease Control and Prevention (CDC) reports that </span></span></span></span></span></span></span><a href="https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm"><span><span><span><span><span><span><span><span><span>25 million</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span> Americans suffer from asthma, and as many as </span></span></span></span></span></span></span><a href="https://www.cdc.gov/copd/index.html"><span><span><span><span><span><span><span><span><span>16 million</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span> suffer from c<a href="https://www.pharmacychecker.com/health/copd/">hronic obstructive pulmonary disease (COPD)</a>. People with both diseases almost always require the use of inhalers, which have become prohibitively expensive for many American families. PharmacyChecker data shows that treating asthma and COPD can be made more affordable through vetted mailorder pharmacies located in other countries. These accredited “international online pharmacies” deliver inhalers to American residents for less than a fourth of U.S. pharmacy prices. </span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span><a href="https://cdn.pharmacychecker.com/pdf/Breathing+Is+Expensive+For+Americans+July+2022+Price+Report.pdf" target="_blank"><img alt="Breathing Is Expensive (For Americans) PharmacyChecker Research July 2022 Preview Image" src="https://cdn.pharmacychecker.com/images/uploads/2022/07/11/reportpreview.png" style="width: 400px; height: 556px; float: right;" /></a>This month’s PharmacyChecker drug price report analyzes both the price and country of origin of </span></span></span></span></span></span></span><a href="https://www.fda.gov/drugs/information-drug-class/drug-treatments-asthma-and-chronic-obstructive-pulmonary-disease-do-not-use-chlorofluorocarbons"><span><span><span><span><span><span><span><span><span>30 inhalers</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span> listed by the U.S. FDA as “Drug Treatments for Asthma and Chronic Obstructive Pulmonary Disease that Do Not Use Chlorofluorocarbons.” The data shows that 77 percent of brand inhalers sold in the United States are manufactured outside the United States. Ten out of the 30 inhalers (33%) have generic availability on U.S. pharmacy shelves, which did not always equate to significant consumer savings compared to the international mailorder pharmacy price. Of the 27 brand inhalers accessible at accredited online pharmacies, international mail-order prices were 78.37% lower than average U.S. pharmacy retail prices. </span></span></span></span></span></span></span></p> <p><a href="https://cdn.pharmacychecker.com/pdf/Breathing+Is+Expensive+For+Americans+July+2022+Price+Report.pdf" target="_blank"><span><span><span><span><span><span><span>Download the Full Drug Price Report Data Here</span></span></span></span></span></span></span></a></p> <section class="ad-banner-horizontal askpc-internal-ad mt-0 mb-3" style="position: relative;"> <a id="askpc-internal-ad" target="_blank" href="/accredited-online-pharmacies/" data-ad-id="1" style="height: 100%; position: relative; box-shadow: 0 0 10px rgba(0,0,0,0.3)" > <img class="no-image-share" src="https://cdn.pharmacychecker.com/images/advertisements/askpc-internal-ad-1.png" height="114" width="729" /> </a> </section> <h2 id="key-findings">Key Findings</h2> <ul> <li aria-level="1"> <p>Seventy-seven percent of brand inhalers sold in the United States are manufactured outside the United States.</p> </li> <li aria-level="1"> <p>Ten out of the 30 inhalers (33%) have generic availability on U.S. pharmacy shelves.</p> </li> <li aria-level="1"> <p>Of the 27 brand inhalers accessible at safe online pharmacies, international mail order prices are 78.37% lower than average U.S. pharmacy retail prices.</p> </li> </ul> <div id="back-to-top" onclick="goToTop();">Back to Top <i class="fa fa-chevron-up"></i></div><h2 id="why-inhalers-are-so-expensive"><span><span><span><span><span><span>Why do inhalers cost so much? </span></span></span></span></span></span></h2> <p><span><span><span><span><span><span><span>Despite it being part of its </span></span></span></span></span></span></span><a href="https://www.fda.gov/about-fda/what-we-do#mission"><span><span><span><span><span><span><span><span><span>stated mission</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span>, the FDA does not consider affordability when evaluating whether a prescription drug should come to market. This is in stark contrast to drug efficacy and </span></span></span></span></span></span></span><a href="https://www.rand.org/news/press/2021/01/28.html"><span><span><span><span><span><span><span><span><span>cost-effectiveness</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span> assessments conducted by </span></span></span></span></span></span></span><a href="https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2017_oct_sarnak_paying_for_rx_ib_v2.pdf"><span><span><span><span><span><span><span><span><span>other high-income countries</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span>. The United States Patent and Trademark Office (USPTO) rewards the </span></span></span></span></span></span></span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146086/"><span><span><span><span><span><span><span><span><span>most minor of tweaks</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span> to drugs – changes that drug companies too often use to keep a lucrative brand pharmaceutical product’s </span></span></span></span></span></span></span><a href="https://www.healthaffairs.org/do/10.1377/forefront.20220615.728560"><span><span><span><span><span><span><span><span><span>hold on the market</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span>. In the case of inhalers, that means taking a medicine that has been around for decades and getting creative with the </span></span></span></span></span></span></span><a href="https://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html"><span><span><span><span><span><span><span><span><span>pumps, delivery systems, and production processes</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span> – perhaps making the inhaler </span></span></span></span></span></span></span><a href="https://lassonde.utah.edu/an-ultra-portable-asthma-inhaler/"><span><span><span><span><span><span><span><span><span>ultra-portable</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span>, for example. </span></span></span></span></span></span></span><span><span><span><span><span><span>“Each time a molecule is put in a new inhaler or combined with another medicine,” writes </span></span></span></span></span></span><a href="https://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-simple-breath.html"><span><span><span><span><span><span><span><span>Elisabeth Rosenthal</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span>, “the amount delivered into the lungs or through the skin may change, even though that often has an imperceptible effect on patients.”</span></span></span></span></span></span></p> <p><span><span><span><span><span><span>In 1987, the United States signed an international environmental agreement to phase out chlorofluorocarbons (CFCs), which were then commonly used as propellants in aerosol canisters, including inhalers. It was only at the end of 2008 that the FDA placed a </span></span></span></span></span></span><a href="https://www.fda.gov/drugs/questions-answers/transition-cfc-propelled-albuterol-inhalers-hfa-propelled-albuterol-inhalers-questions-and-answers#:~:text=Albuterol%20inhalers%20that%20contain%20chlorofluorocarbons,place%20of%20albuterol%20CFC%20inhalers."><span><span><span><span><span><span><span><span>ban on all inhalers containing CFCs</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span>, giving pharmaceutical companies plenty of time to prepare a new propellant formulation and accompanying patent strategies. </span></span></span></span></span></span></p> <p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675349/#R3"><span><span><span><span><span><span><span><span>Prices</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span> immediately went from $13-17 per CFC inhaler to $38-53 for the new, branded hydrofluoroalkane (HFA) inhalers. PharmacyChecker found that the retail price of </span></span></span></span></span></span><a href="https://www.pharmacychecker.com/proair+hfa/#prices"><span><span><span><span><span><span><span><span>ProAir HFA</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span> more than doubled, from $41.84 in 2009 to $100.17 in 2022. An analysis published in the </span></span></span></span></span></span><a href="https://jamanetwork.com/journals/jama/article-abstract/2792986"><span><span><span><span><span><span><span><span>Journal of the American Medical Association</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span> found that average prices for newly marketed prescription drugs, in general, grew tenfold from 2008 to 2021.</span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span>Prolonging the period that a drug company is allowed market exclusivity inevitably impacts patients’ finances – and health. About three in ten (</span></span></span></span></span></span></span><a href="https://www.kff.org/health-costs/press-release/poll-nearly-1-in-4-americans-taking-prescription-drugs-say-its-difficult-to-afford-medicines-including-larger-shares-with-low-incomes/"><span><span><span><span><span><span><span><span><span>29%</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span>) American adults do not take their medicines as prescribed due to high costs. </span></span></span></span></span></span></span></p> <p><span><span><span><span><span><span>In 2022, as found in PharmacyChecker’s analysis, only 33% of the inhalers that do not use CFCs face generic competition. Proair HFA is one of them. The generic is $52.00 on average in U.S. pharmacies, a 48% savings compared to the brand. On average, inhaler generic availability saves patients 40.85%. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span><span>As if drug manufacturers’ sly dealings weren’t enough, they are certainly </span></span></span></span></span></span></span><a href="https://www.pharmacychecker.com/askpc/why-are-drug-prices-high-in-the-us/"><span><span><span><span><span><span><span><span><span>not the sole culprit</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span> in our drug price headache. The Federal Trade Commission recently </span></span></span></span></span></span></span><a href="https://www.ftc.gov/news-events/news/press-releases/2022/06/ftc-launches-inquiry-prescription-drug-middlemen-industry"><span><span><span><span><span><span><span><span><span>launched</span></span></span></span></span></span></span></span></span></a><span><span><span><span><span><span><span> a probe into the suspicious practices of pharmacy benefit managers (PBMs). PBMs, like CVS Caremark, Express Scripts, and OptumRx, are central to the private insurance market, deciding which drugs go on formularies and how much to reimburse payers. Lack of transparency in these practices is often cited as another reason drug prices are so high.  </span></span></span></span></span></span></span></p> <div id="back-to-top" onclick="goToTop();">Back to Top <i class="fa fa-chevron-up"></i></div> <section class="ad-banner-horizontal askpc-internal-ad mt-0 mb-3" style="position: relative;"> <a id="askpc-internal-ad" target="_blank" href="/accredited-online-pharmacies/" data-ad-id="1" style="height: 100%; position: relative; box-shadow: 0 0 10px rgba(0,0,0,0.3)" > <img class="no-image-share" src="https://cdn.pharmacychecker.com/images/advertisements/askpc-internal-ad-1.png" height="114" width="729" /> </a> </section> <h2 id="inhaler-prices"><span><span><span><span><span><span><span>Brand Inhaler Prices and Generic Availability at U.S. pharmacies vs. International Online Pharmacies, 2022</span></span></span></span></span></span></span></h2> <table class="table table-striped" > <tbody> <tr> <td><strong>Brand Inhaler </strong>(generic)</td> <td><strong>US generic availability</strong></td> <td><strong>Strength</strong></td> <td><strong>US Retail Price</strong></td> <td><strong>International Mail Order Price</strong></td> <td><strong>International Savings</strong></td> </tr> <tr> <td>Tudorza Pressair (aclidinium bromide)</td> <td>no</td> <td>400mcg</td> <td>$756.74</td> <td>$92.99</td> <td>87.71%</td> </tr> <tr> <td>Proventil HFA (albuterol sulfate)</td> <td>yes</td> <td>6.7g of 90mcg</td> <td>$96.82</td> <td>N/A</td> <td> </td> </tr> <tr> <td>Ventolin HFA (albuterol sulfate)</td> <td>yes</td> <td>18g of 90mcg</td> <td>$77.86</td> <td>$26.61</td> <td>65.82%</td> </tr> <tr> <td>ProAir HFA (albuterol sulfate)</td> <td>yes</td> <td>8.5g of 90mcg</td> <td>$100.17</td> <td>$39.95</td> <td>60.12%</td> </tr> <tr> <td>ProAir Respiclick (albuterol sulfate)</td> <td>no</td> <td>0.65g of 90mcg</td> <td>$94.00</td> <td>$39.95</td> <td>57.50%</td> </tr> <tr> <td>Combivent Respimat (albuterol sulfate & ipratropium bromide)</td> <td>no</td> <td>20mcg/100mcg</td> <td>$512.00</td> <td>$58.99</td> <td>88.48%</td> </tr> <tr> <td>Duoneb (albuterol sulfate & ipratropium bromide)**</td> <td>yes</td> <td>3ml of 0.5mg/3mg/3ml</td> <td>$172.00</td> <td>$83.99</td> <td>51.17%</td> </tr> <tr> <td>Brovana (arformoterol tartrate)</td> <td>yes</td> <td>2ml vials of 15mcg/2ml</td> <td>$1,379.36</td> <td>N/A</td> <td> </td> </tr> <tr> <td>QVAR (beclomethasone dipropionate)</td> <td>no</td> <td>10.6g of 80mcg</td> <td>$308.00</td> <td>$69.68</td> <td>77.38%</td> </tr> <tr> <td>Pulmicort Turbohaler (budesonide)</td> <td>no</td> <td>180mcg</td> <td>$311.00</td> <td>$59.00</td> <td>81.03%</td> </tr> <tr> <td>Pulmicort Flexhaler (budesonide)</td> <td>no</td> <td>90mcg</td> <td>$232.00</td> <td>$34.95</td> <td>84.94%</td> </tr> <tr> <td>Symbicort (budesonide & formoterol fumarate)</td> <td>yes</td> <td>160mcg/4.5mcg</td> <td>$449.00</td> <td>$43.20</td> <td>90.38%</td> </tr> <tr> <td>Alvesco (ciclesonide)</td> <td>no</td> <td>160mcg</td> <td>$315.00</td> <td>$68.99</td> <td>78.10%</td> </tr> <tr> <td>Breo Ellipta (fluticasone furoate & vilanterol trifenatate)</td> <td>no</td> <td>100mcg/25mcg</td> <td>$460.00</td> <td>$64.99</td> <td>85.87%</td> </tr> <tr> <td>Flovent HFA (fluticasone propionate HFA)</td> <td>no</td> <td>110mcg</td> <td>$289.00</td> <td>$29.96</td> <td>89.63%</td> </tr> <tr> <td>Flovent Diskus (fluticasone propionate)</td> <td>no</td> <td>100mcg</td> <td>$258.00</td> <td>$27.99</td> <td>89.15%</td> </tr> <tr> <td>Perforomist (formoterol fumarate)</td> <td>yes</td> <td>2ml of 20mcg/2ml</td> <td>$1,355.66</td> <td>N/A</td> <td> </td> </tr> <tr> <td>Arcapta Neohaler (indacaterol)</td> <td>no</td> <td>75mcg</td> <td>$309.08</td> <td>$89.95</td> <td>70.90%</td> </tr> <tr> <td>Atrovent HFA (ipratropium bromide)</td> <td>no</td> <td>12.9g of 17mcg</td> <td>$525.14</td> <td>$36.00</td> <td>93.14%</td> </tr> <tr> <td>Xopenex (levalbuterol sulfate)</td> <td>yes</td> <td>3ml vials of 1.25mg/3ml</td> <td>$299.97</td> <td>$23.90</td> <td>92.03%</td> </tr> <tr> <td>Asmanex (mometasone furoate)</td> <td>no</td> <td>220mcg</td> <td>$271.67</td> <td>$96.95</td> <td>64.31%</td> </tr> <tr> <td>Asmanex Twisthaler (mometasone furoate)</td> <td>no</td> <td>220mcg</td> <td>$291.03</td> <td>$87.99</td> <td>69.77%</td> </tr> <tr> <td>Dulera (mometasone furoate & formoterol fumarate)</td> <td>no</td> <td>200mcg/5mcg</td> <td>$391.80</td> <td>$159.99</td> <td>59.17%</td> </tr> <tr> <td>Striverdi Respimat (olodaterol)</td> <td>no</td> <td>2.5mcg/actuation</td> <td>$281.00</td> <td>$85.95</td> <td>69.41%</td> </tr> <tr> <td>Serevent Diskus (salmeterol xinafoate)</td> <td>no</td> <td>50mcg</td> <td>$498.18</td> <td>$94.99</td> <td>80.93%</td> </tr> <tr> <td>ADVAIR Diskus (salmeterol xinafoate/fluticasone propionate)</td> <td>yes</td> <td>250mcg/50mcg</td> <td>$469.38</td> <td>$57.60</td> <td>87.73%</td> </tr> <tr> <td>ADVAIR HFA (salmeterol xinafoate/fluticasone propionate)</td> <td>yes</td> <td>115mcg/21mcg</td> <td>$450.00</td> <td>$44.99</td> <td>90.00%</td> </tr> <tr> <td>Spiriva Respimat (tiotropium bromide)</td> <td>no</td> <td>2.5mcg/actuation</td> <td>$525.00</td> <td>$84.99</td> <td>83.81%</td> </tr> <tr> <td>Spiriva Handihaler (tiotropium bromide)</td> <td>no</td> <td>18mcg</td> <td>$589.61</td> <td>$35.92</td> <td>93.91%</td> </tr> <tr> <td>Incruse Ellipta (umeclidinium)</td> <td>no</td> <td>62.5mcg</td> <td>$424.00</td> <td>$95.68</td> <td>77.43%</td> </tr> <tr> <td>Anoro Ellipta (umeclidinium & vilanterol)</td> <td>no</td> <td>62.5mcg/25mcg</td> <td>$533.00</td> <td>$136.29</td> <td>74.43%</td> </tr> <tr> <td> </td> <td> </td> <td> </td> <td> </td> <td>Average Savings:</td> <td>78.37%</td> </tr> </tbody> </table> <p><small>PharmacyChecker Research July 2022. Prices listed are per inhaler. Average U.S. Retail Pharmacy Prices from GoodRx.com and Drugs.com; U.S. Coupon Prices from PharmacyChecker.com and GoodRx.com; International Pharmacy Prices from PharmacyChecker.com. Sample of inhalers based on those identified by the FDA as "Drug Treatments for Asthma and Chronic Obstructive Pulmonary Disease that Do Not Use Chlorofluorocarbons."</small></p> <div id="back-to-top" onclick="goToTop();">Back to Top <i class="fa fa-chevron-up"></i></div><h2 id="importing-inhalers-from-abroad"><span><span><span><span><span><span>Importing Inhalers From Foreign Countries</span></span></span></span></span></span></h2> <p><span><span><span><span><span><span>The PharmacyChecker report shows that 77 percent of brand inhalers sold in the United States are manufactured elsewhere. Those countries of origin include Germany, the United Kingdom, Singapore, Ireland, Sweden, France, Italy, and Switzerland. </span></span></span></span></span></span></p> <p><span><span><span><span><span><span>Five inhalers in the dataset are manufactured in Germany, a country where regulators use </span></span></span></span></span></span><a href="https://www.commonwealthfund.org/blog/2019/how-drug-prices-are-negotiated-germany"><span><span><span><span><span><span><span><span>collective negotiation</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span> to set drug wholesale and retail prices. Should a patient in the United States decide to import their medication from a vetted international online pharmacy, they will spend 85.75% less than the price of the German-made medication sold at their local U.S. pharmacy.</span></span></span></span></span></span></p> <h3><span><span><span><span><span><span>Price of German-made Brand Name Inhalers Sold in U.S. Pharmacies vs. International Mail Order Prices, 2022</span></span></span></span></span></span></h3> <table class="table table-striped table table-striped"> <tbody> <tr> <td><strong>Brand Name</strong></td> <td><strong>US Generic Availability</strong></td> <td><strong>Strength</strong></td> <td><strong>Average US Retail Price</strong></td> <td><strong>International Mail Order Price</strong></td> <td><strong>International Savings</strong></td> <td><strong>Manufacturing Origin</strong></td> </tr> <tr> <td>Combivent Respimat</td> <td>no</td> <td>20mcg/100mcg</td> <td>$512.00</td> <td>$58.99</td> <td>88.48%</td> <td>Germany</td> </tr> <tr> <td>Atrovent HFA</td> <td>no</td> <td>12.9g of 17mcg</td> <td>$525.14</td> <td>$36.00</td> <td>93.14%</td> <td>Germany</td> </tr> <tr> <td>Striverdi Respimat Inhalation Spray</td> <td>no</td> <td>2.5mcg/actuation</td> <td>$281.00</td> <td>$85.95</td> <td>69.41%</td> <td>Germany</td> </tr> <tr> <td>Spiriva Respimat Inhalation Spray</td> <td>no</td> <td>2.5mcg/actuation</td> <td>$525.00</td> <td>$84.99</td> <td>83.81%</td> <td>Germany</td> </tr> <tr> <td>Spiriva Handihaler</td> <td>no</td> <td>18mcg</td> <td>$589.61</td> <td>$35.92</td> <td>93.91%</td> <td>Germany</td> </tr> </tbody> </table> <p><small>PharmacyChecker Research July 2022. Sources: Country of manufacture determined through the National Library of Medicine and FDA Labeling Package Insert drug information. </small></p> <p><span><span><span><span><span><span>Most brand products sold in the United States are manufactured in other countries that have comparable if not </span></span></span></span></span></span><a href="https://www.pharmacychecker.com/research/not-made-in-the-usa/"><span><span><span><span><span><span><span><span>stronger systems of pharmaceutical manufacturing</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span> than the U.S., but the pharmaceutical supply chain is constantly evolving. Breztri, an aerosol inhalant COPD treatment, sold in the United States is manufactured by drug company AstraZeneca in </span></span></span></span></span></span><a href="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=715433dc-cb2b-43ea-b6df-c5b4177adc6c"><span><span><span><span><span><span><span><span>France</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span>. In June 2022, AstraZeneca </span></span></span></span></span></span><a href="https://www.fiercepharma.com/manufacturing/astrazeneca-build-copd-inhalant-manufacturing-facility-china"><span><span><span><span><span><span><span><span>announced</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span> that they plan to build a manufacturing facility in Qingdau, China to produce Breztri. This does not necessarily mean future Breztri on U.S. shelves will be made in China, but it’s certainly of interest to those concerned about the drug supply chain. </span></span></span></span></span></span><a href="https://www.citizen.org/article/china-is-the-top-source-of-us-pharmaceutical-imports/"><span><span><span><span><span><span><span><span>China leads</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span> as the top country from which bulk pharmaceutical ingredients are imported into the U.S. – mostly for generic and over-the-counter medications. </span></span></span></span></span></span></p> <div id="back-to-top" onclick="goToTop();">Back to Top <i class="fa fa-chevron-up"></i></div> <section class="ad-banner-horizontal askpc-internal-ad mt-0 mb-3" style="position: relative;"> <a id="askpc-internal-ad" target="_blank" href="/accredited-online-pharmacies/" data-ad-id="1" style="height: 100%; position: relative; box-shadow: 0 0 10px rgba(0,0,0,0.3)" > <img class="no-image-share" src="https://cdn.pharmacychecker.com/images/advertisements/askpc-internal-ad-1.png" height="114" width="729" /> </a> </section> <h2 id="us-inhalers-manufacturing-origin"><span><span><span><span><span><span>Manufacturing Locations of Inhalers Sold in the United States, 2022</span></span></span></span></span></span></h2> <table class="table table-striped table table-striped"> <tbody> <tr> <td><strong>Brand Name</strong></td> <td><strong>Where the Brand is Made</strong></td> </tr> <tr> <td>Tudorza Pressair</td> <td>USA</td> </tr> <tr> <td>Proventil HFA</td> <td>Made in Italy. Formulated in USA. Actuator made in USA.</td> </tr> <tr> <td>Ventolin HFA</td> <td>UK</td> </tr> <tr> <td>ProAir HFA</td> <td>Ireland</td> </tr> <tr> <td>ProAir Respiclick</td> <td>Ireland</td> </tr> <tr> <td>Combivent Respimat</td> <td>Germany</td> </tr> <tr> <td>Duoneb Inhalation Solution</td> <td>USA</td> </tr> <tr> <td>Brovana Inhalation Solution</td> <td>USA</td> </tr> <tr> <td>QVAR</td> <td>Ireland</td> </tr> <tr> <td>Pulmicort Turbohaler</td> <td>Product of Sweden</td> </tr> <tr> <td>Pulmicort Flexhaler</td> <td>Manufactured in Sweden; Product of Netherlands</td> </tr> <tr> <td>Symbicort Inhalation Aerosol</td> <td>France</td> </tr> <tr> <td>Alvesco Inhalation Aerosol</td> <td>UK</td> </tr> <tr> <td>Aerospan HFA</td> <td>Discontinued</td> </tr> <tr> <td>Breo Ellipta</td> <td>USA</td> </tr> <tr> <td>Flovent HFA</td> <td>Singapore</td> </tr> <tr> <td>Flovent Diskus</td> <td>USA</td> </tr> <tr> <td>Foradil Aerolizer</td> <td>Discontinued</td> </tr> <tr> <td>Perforomist Inhalation Solution</td> <td>USA</td> </tr> <tr> <td>Arcapta Neohaler</td> <td>Switzerland</td> </tr> <tr> <td>Atrovent HFA</td> <td>Germany</td> </tr> <tr> <td>Xopenex</td> <td>USA</td> </tr> <tr> <td>Asmanex Inhalation Aerosol HFA</td> <td>Made in Singapore; Formulated in the UK; Actuator made in Germany</td> </tr> <tr> <td>Asmanex Twisthaler</td> <td>Singapore</td> </tr> <tr> <td>Dulera Inhalation Aerosol</td> <td>UK (actuator made in Germany)</td> </tr> <tr> <td>Striverdi Respimat Inhalation Spray</td> <td>Germany</td> </tr> <tr> <td>Serevent Diskus</td> <td>USA</td> </tr> <tr> <td>ADVAIR Diskus</td> <td>England</td> </tr> <tr> <td>ADVAIR HFA</td> <td>USA</td> </tr> <tr> <td>Spiriva Respimat</td> <td>Germany</td> </tr> <tr> <td>Spiriva Handihaler</td> <td>Germany</td> </tr> <tr> <td>Incruse Ellipta</td> <td>Singapore</td> </tr> <tr> <td>Anoro Ellipta</td> <td>USA</td> </tr> </tbody> </table> <p><small>PharmacyChecker Research July 2022. Sources: Country of manufacture determined through the National Library of Medicine and FDA Labeling Package Insert drug information. Identification of inhalers based on those identified by the FDA as "Drug Treatments for Asthma and Chronic Obstructive Pulmonary Disease that Do Not Use Chlorofluorocarbons."</small></p> <div id="back-to-top" onclick="goToTop();">Back to Top <i class="fa fa-chevron-up"></i></div><h2 id="ordering-inhalers-online"><span><span><span><span><span><span><img alt="Jeffrey Poirier, VP of the PharmacyChecker Verification Program" src="https://cdn.pharmacychecker.com/images/uploads/2022/07/11/jeffpicround.PNG" style="width: 238px; height: 239px; float: left;" />Ordering Inhalers From Foreign Countries Through Online Pharmacies</span></span></span></span></span></span></h2> <p><span><span><span><span><span><span>PharmacyChecker’s report found that international mail order prices of inhalers are 78.37% lower than average U.S. pharmacy retail prices. The way inhalers are priced and marketed varies across the globe. </span></span></span></span></span></span><a href="https://www.pharmacychecker.com/aboutus/"><span><span><span><span><span><span><span><span>Jeffrey Poirier</span></span></span></span></span></span></span></span></a><span><span><span><span><span><span> is the Vice President of the PharmacyChecker Verification Program, in which online pharmacies are vetted and monitored for high standards of pharmacy practice. He shared his thoughts concerning the soaring price of inhalers in the United States:</span></span></span></span></span></span></p> <p><cite><span><span><span><span><span>The prices of inhalers in the USA are much too expensive for such critical medications.  Patients are forced to seek alternative ways to obtain their inhalers. PharmacyChecker can help by providing a source of verified online pharmacies that can access the same or similar inhalers from other countries at reduced prices.”</span></span></span></span></span></cite></p> <p><span><span><span><span><span><span>Inhaler prices, strengths, and brand names vary across countries. We asked Jeff some questions from patients who are interested in understanding how to import inhalers.</span></span></span></span></span></span></p> <ol> <li aria-level="1"><strong><span><span><span><span><span><span>Why are inhalers so drastically cheaper at online pharmacies? </span></span></span></span></span></span></strong></li> </ol> <p><span><span><span><span><span><span>Different countries pay different prices for the same medications. Online pharmacies give you access to these medications at reduced prices from other countries.</span></span></span></span></span></span></p> <ol start="2"> <li aria-level="1"><strong><span><span><span><span><span><span>Why do inhaler strengths slightly differ across countries? My Symbicort prescription is for an 80mcg/4.5mcg inhaler. I see that some PharmacyChecker-accredited websites say that 100mcg/6mcg is equivalent. Is that true?  </span></span></span></span></span></span></strong></li> </ol> <p><span><span><span><span><span><span>Because inhaler strengths also vary across countries, any changes such as the strength of the active ingredients would need to be approved by your prescriber. These changes would generally be considered clinically equivalent and are due to different marketing strategies in different countries.</span></span></span></span></span></span></p> <ol start="3"> <li aria-level="1"><strong><span><span><span><span><span><span>Why is the brand name of my inhaler different in New Zealand? Are they the same inhaler?</span></span></span></span></span></span></strong></li> </ol> <p><span><span><span><span><span><span>Even the marketed brand names of inhalers differ across countries. You should always refer to the active ingredients and their strengths to determine if they are equivalent.</span></span></span></span></span></span></p> <ol start="4"> <li aria-level="1"><strong><span><span><span><span><span><span>The generic of my inhaler is not available at US pharmacies, but is available at an accredited online pharmacy… and it’s much cheaper than the brand. Can I order a generic if the generic isn’t approved in the USA? </span></span></span></span></span></span></strong></li> </ol> <p><span><span><span><span><span><span>If the active ingredients are the same and your prescriber has approved a generic, you should be able to obtain the generic from another country even if it is not available at U.S. pharmacies. </span></span></span></span></span></span></p> <ol start="5"> <li aria-level="1"><strong><span><span><span><span><span><span>If my doctor writes a prescription for a certain strength, but the strength sold at the pharmacy is slightly different, will they still fill my prescription? </span></span></span></span></span></span></strong></li> </ol> <p><span><span><span><span><span><span>Any changes in strength should be approved by your prescriber.</span></span></span></span></span></span></p> <p><div id="popup-bg" class="popup-overlay d-none"> </div> <div id="generic-popup" class="popup d-none"> <div class="close-button" onclick="hidePopup()"><i class="fa fa-close fa-2x" style="color: white;"> </i></div> <div class="text-center"> <div class="top-section"> <h3 class="mt-4 mx-4 mx-sm-2" style="font-weight: normal; font-size: 1.75rem; color: white; text-shadow: 0 0 10px rgba(0,0,0,0.8);">Consumer safety above all.</h3> <span class="my-3 mx-2 mx-sm-4 subtitle" style="color: white; text-shadow: 0 0 10px rgba(0,0,0,0.8);">We vet and monitor international online pharmacies for patient safety</span> </div> <div class="bottom-section"> <div class="my-4 mx-2 d-flex"><a class="btn-purple m-auto" href="/accredited-online-pharmacies/?src=breathing-is-expensive-for-americans">See Accredited Pharmacies</a></div> </div> </div> </div></p><div id="back-to-top" onclick="goToTop();">Back to Top <i class="fa fa-chevron-up"></i></div></div> <div class="row my-4 cta-search-container"> <div class="col-12 drug-comparison text-center"> <h2 class="my-4"> Compare drug prices among reputable online pharmacies </h2> </div> <div class="col-12 cta-search"> <form class="search global-search form-inline" method="post" action="/drug-prices/search/" target="_top"> <div class="input-group">  <input type="hidden" name="csrfmiddlewaretoken" value="VYiX6ryBdMGUByUDn3UQhHoKNZ7gc0d8DEiXCHRV38ZTijPhnj6ax2isqHiqOJF8"> <input type="text" name="q" id="global-search" class="form-control" data-drug-suggest="true" placeholder="Type Drug Name" aria-label="Enter drug name" maxlength="255" minlength="2" required> <button aria-label='Search drug prices'><i class="fa fa-search fa-lg"></i></button> </div> </form> </div> </div> <a name="comments"></a> <div class="comments"> <div class="list"> <div class="comments-header">Comments</div> <div class="empty">Sign in below and start the conversation!</div> </div> <div class="new"> <div class="comments-header"> <a rel="nofollow" href="/login/?redirect_to=/askpc/breathing-is-expensive-for-americans/%23comments">Login</a> or <a rel="nofollow" href="/register/?redirect_to=/askpc/breathing-is-expensive-for-americans/%23comments">Register</a> to Comment </div> </div> </div> <section class="sidebar-block sidebar-join-askpc-discussion"> <div style="min-width: 200px;" class="text-center"><a href="/askpc/most-popular-recent-questions/" style="text-decoration: none;"><h3 class="my-3">Ask PharmacyChecker</h3></a></div> <div style="min-width: 200px;"> <div class="d-flex"> <a class="btn-purple mx-auto mt-0 mb-2" href="/askpc/ask/"> Ask a Question </a> </div> </div> <p class="mt-1"> PharmacyChecker experts answer consumer questions related to obtaining lower-cost, prescription medications. </p> <p> We help people afford the medication they need by verifying online pharmacies and comparing their prices. 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Breathing is Expensive (For Americans) | PharmacyChecker.com