A bill that would set a $25 limit on inhaler copays for a 30-day supply was approved by the Illinois General Assembly’s Insurance Committee last week.
House Bill 4504 sponsor Rep. Laura Faver Dias (D-Grayslake) said it would remove financial barriers to necessary medications for people with acute respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD).
Dias told the committee that a CDC-funded study found that the annual per-person medical cost of prescription inhalers is $1,830, or $152 a month.
Since introducing HB 4504 in January, Dias said her office has received several emails from people sharing their out-of-pocket monthly costs for inhalers, noting they range from $188 to $230. One person stated they paid $645 a month. The price of medication can vary significantly based on the severity of a person’s illness.
Prescriptions are not the only expenses incurred by people with respiratory illnesses. They also may incur additional costs due to missed work, missed school, and emergency visits. The Centers for Disease Control and Prevention (CDC) says asthma alone accounts for 439,000 hospitalizations and 1.7 million emergency department visits per year.
According to the Asthma and Allergy Foundation of America, the annual cost of all asthma-related expenses—including medications and treatment, missed work and school, and death—was $81.9 billion annually between 2008 and 2013.
Kristina Hamilton, the Illinois advocacy director for the American Lung Association (ALA), said ALA strongly supports HB 4504.
“All patients with asthma—regardless of its severity—require two inhalers, so that includes a quick relief inhaler and a controller. Some people with more severe disease require three inhalers. This bill would have a major impact, especially for those people with more severe disease, to help them control their symptoms and also help them control the cost.”
— Hamilton
Some of the symptoms of asthma and COPD include coughing, shortness of breath, fatigue, and chest tightness. To control the symptoms of these acute respiratory illnesses, patients must take their medications as prescribed.
“Prescription inhalers really help to relieve those systems, and can keep people out of the hospital and honestly keep them alive,” Hamilton said.
The CDC states that approximately 10 people die from asthma per day, and that Black Americans are two to three times more likely to die from asthma than any other racial group.
Regardless of the possible complications associated with asthma, some people do not fill their prescriptions because they cannot afford them. The CDC says patients with higher-than-average copays are less likely to fill first-time prescriptions.
Hamilton also cited a literature review published by KFF which “found that even small levels of cost-sharing for medications, $1 to $5, was associated with reduced use of care, including necessary services,” she said.
Rep. Jeff Keicher (R-Sycamore) expressed concern that a lower copay would push the cost burden onto insurance plans, therefore causing insurance rates to rise. He also asked Hamilton and Dias where HB 4504’s proposed $25 limit originated from, because he said it seems like an arbitrary number that many families could afford.
“We tried to be in line with similar policies around [medications] like insulin being capped around $35,” Hamilton said. “Given a lot of people with asthma and COPD have three prescription inhalers, that’s still $75 which really can be cost-burdensome for a lot of families. It’s hard to—as [Keicher] mentioned—have an exact remedy and right figure, but we just felt, given that people usually have multiple inhalers, that $25 would be reasonable.”
HB 4504 now awaits scheduling for a second reading in the House.
Readers can learn more about health-related legislation at the 2024 Illinois State of Reform Health Policy Conference, which will be held on May 29 at the Fairmont Chicago Millennium Park. Those interested can register here.