Could Medicare Help You Save on Expensive Asthma Inhalers?

Prices for asthma inhalers in the U.S. can take your breath away.

Skyrocketing inhaler costs pose a financial barrier for many of the 25 million Americans with asthma. The average cash price inhalers increased from $280 in 2013 to $380 in 2018, according to GoodRx.

If you need an inhaler and are on Medicare, the federal health insurance program for seniors and people with certain disabilities, a little-known option may help you reduce your medication costs — perhaps even dramatically.

We will explain how to find out if you are eligible. First, though, it’s useful to know something about Medicare’s coverage and inhalers.

Common ways to reduce inhaler costs

If your doctor prescribes an asthma inhaler, you may get help with the cost if you have prescription drug coverage — through a Part D drug plan, or a Medicare Advantage plan that includes drug coverage.

Even with insurance, however, your cost may be huge. The drug you need may not be covered by your insurance plan. Or, it may be covered, but remain unaffordable. As GoodRx says:

“… many popular inhalers are often placed on lower tiers of coverage, meaning that patients face higher copays or find their preferred medication excluded altogether.”

GoodRx lists four ways to cut costs on inhalers:

• Check your insurer’s list of covered drugs, which is often called a formulary. If your insurance plan doesn’t cover the drug you need, consider switching to a plan that does. Medicare’s open enrollment periods are the annual windows for switching insurance plans.
• If your insurance plan doesn’t cover the drug you need, another option is to file an appeal.
• Ask your doctor if you can use a cheaper generic drug instead.
• Check the drug manufacturer’s website or contact the manufacturer to see if it offers a patient assistance program or coupon to lower your cost.
• Check GoodRx.com for a coupon. The site says it offers discounts for all FDA-approved inhalers.

A little-known money-saving alternative to inhalers

There’s yet another option for lowering inhaler costs, a less-known workaround using Medicare Part B.

Medicare Part B covers outpatient medical services, including visits to doctors. It also covers some types of durable medical equipment — like nebulizers — and some asthma medicines delivered by a nebulizer.

A nebulizer is basically a small air compressor that pumps liquid medicine into a mist that you inhale through a mouthpiece. Nebulizers are generally easy to use — they’re often prescribed for children with asthma, who can struggle to use an inhaler.

The savings for a patient who takes the nebulizer route can be huge. In my case, Medicare Part B covered the cost of a Philips Respironics nebulizer ($30 to $60) and my nebulizer medication ($1,200 per month). My copay — 20% — was paid by my Medigap supplemental insurance plan.

There’s a potential drawback: the nebulizer. Unlike an inhaler, which fits in your pocket or purse, nebulizers can be bulky and require an electric outlet or batteries. The treatment may require you to sit in one place and inhale the medicine for around five to 10 minutes. An inhaler, in comparison, takes about 30 seconds to use.

Will a nebulizer alternative will work for you?

To try this route, here’s what to do:

1. Ask your prescribing doctor or pharmacist if a nebulizer alternative is available for the inhaler your doctor has prescribed or plans to prescribe.
2. Confirm that your doctor and pharmacy are “enrolled” in Medicare. This is critical. Also, ask if the pharmacy is a “Medicare durable medical equipment” (DME) supplier. If not, you could get stuck with a big bill. (Read Medicare’s warning about this.)
3. Ask the pharmacist to explain what your final price will be after Medicare Part B insurance is applied.
4. If all looks good, ask your doctor to write a prescription for the nebulizer medicine. You’ll need a second, separate prescription for a nebulizer itself. If your insurance doesn’t cover the nebulizer, consider purchasing it yourself. Unlike the medicine, the nebulizer is a one-time expense.