What do you recommend patients with no insurance do when they can't afford their inhaler?

[n64bomb]

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Let's say you have a patient on medium dose ICS/LABA and can't afford it. Assume he/she has no allergies. If they can't afford it, I see about the doctor changing it to airduo and using the goodrx card. This patient has no insurance. Have another patient who can't afford Dulera 200. The savings cards for symbicort/dulera/breo aren't very good anymore. I recommended they try advair diskus generic on the goodrx card.

What do recommend to people when they have no insurance and can't afford the expensive inhaler?

 

[deleted480308]

If they get bad enough to get admitted, I tell them to ask for the actually inhaler instead of nebs so they can at least leave with some doses

 

[VA Hopeful Dr]

Airduo

 

[accordman83]

Advair patient assistance, 90 days shipped right to their door at no cost to them.

 

[NITRAS]

If they get bad enough to get admitted, I tell them to ask for the actually inhaler instead of nebs so they can at least leave with some doses

Before COVID, we didn't have inhalers. None. We also got rid of individual insulin bottles. The ones we do have are reserved for COVID patients.

 

[KidPharmD]

Usually these patients will qualify for actual assistance from the drug company. NeedyMeds usually has the contact information for the relevant PAP.

 

[Sine Cura]

Recommend voting for health care subsidy reform

 

[deleted480308]

Also, stop smoking

 

[Mad Jack]

If they get bad enough to get admitted, I tell them to ask for the actually inhaler instead of nebs so they can at least leave with some doses

A lot of hospitals bar you from allowing patients to keep them, as hospital pharmacies aren't allowed to dispense outpatient meds in many states. I've done it wayyyy in the past, but it was very against the rules

 

[deleted480308]

A lot of hospitals bar you from allowing patients to keep them, as hospital pharmacies aren't allowed to dispense outpatient meds in many states. I've done it wayyyy in the past, but it was very against the rules

Well god bless my state then

 

[allantois]

Saw a flight attendant with COPD who would get her inhalers for a couple of bucks whenever she flew to Europe. It’s a darn shame what our healthcare has become

 

[TheBlaah]

I was under the impression most hospital don't allow inpatient medications to be taken outpatient due to labelling requirements and packaging requirements. A lot of inpatient pharmacies simply don't have the system and printer available to do that.

That being said, it's still probably against the rules for a patient to keep an inhaler that was initially dispensed inpatient. Our hospital has to have the doctor specifically order and the pharmacy package and pre-labelled and pre-packaged albuterol inhalers for outpatient use after normal business hours.

 

[Rockinacoustic]

I was under the impression most hospital don't allow inpatient medications to be taken outpatient due to labelling requirements and packaging requirements. A lot of inpatient pharmacies simply don't have the system and printer available to do that.

That being said, it's still probably against the rules for a patient to keep an inhaler that was initially dispensed inpatient. Our hospital has to have the doctor specifically order and the pharmacy package and pre-labelled and pre-packaged albuterol inhalers for outpatient use after normal business hours.

It's an especially dumb licensing requirement that COVID has exacerbated. How many Ventolin inhalers with 194 puffs remaining are wasted after discharge from the ED.

 

[zelman]

It's an especially dumb licensing requirement that COVID has exacerbated. How many Ventolin inhalers with 194 puffs remaining are wasted after discharge from the ED.

They should be using the 8gm 60 puff ones

 

[maria1oh]

The 8 gm 60 puff was discontinued I thought

 

[grumpyRph]

Airduo

this must not be a *thing* in my region. never heard of this/seen it. lol

 

[Sine Cura]

Airduo is a recent 505(b)(2) approval kinda like Basaglar or Admelog but not really because of the arbitrary dose combos of fluticasone and salmeterol.

I never seen "brand" Airduo ever but the authorized generic has been available for a couple of years

 

[confettiflyer]

A lot of hospitals bar you from allowing patients to keep them, as hospital pharmacies aren't allowed to dispense outpatient meds in many states. I've done it wayyyy in the past, but it was very against the rules

Your state board didn’t waive rules for Covid? What kind of lame state board is that


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[confettiflyer]

It's an especially dumb licensing requirement that COVID has exacerbated. How many Ventolin inhalers with 194 puffs remaining are wasted after discharge from the ED.

Lazy boards of pharmacy not waiving rules.

CA rules waived and most major EMR systems can easily convert to meet OP labeling reqs.

Even if it doesn’t... have one of your techs make preprinted labels using MS Word and address labels.

We’ve wasted zero inhalers over here once waivers came through in March, but we always had the ability (5% of volume rule)


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[VA Hopeful Dr]

Saw a flight attendant with COPD who would get her inhalers for a couple of bucks whenever she flew to Europe. It’s a darn shame what our healthcare has become

Blame the government for this one. When the EPA demanded that inhalers stop using CFCs as propellent, the drug companies managed to get new patents for the new mechanisms. It's why we used to have generic Albuterol inhalers but now don't.

 

[deleted480308]

Blame the government for this one. When the EPA demanded that inhalers stop using CFCs as propellent, the drug companies managed to get new patents for the new mechanisms. It's why we used to have generic Albuterol inhalers but now don't.

I mean didn’t it used be <$20? Like it was silly cheap

 

[VA Hopeful Dr]

I mean didn’t it used be <$20? Like it was silly cheap

I don't remember specifics as this happened before I started med school, the big thing to my thinking is that we basically got a reset of the generic clock for all inhalers.

 

[deleted480308]

I don't remember specifics as this happened before I started med school, the big thing to my thinking is that we basically got a reset of the generic clock for all inhalers.

Did some googling, yeah used to be less than $20

 

[Sine Cura]

U.S. health care delivery is dumb as ****. I don't even know why people defend this zombie garbage except for that fact that you are paid better than anywhere else. BeSt MeDiCaL cArE iN tHe WoRlD

 

[VA Hopeful Dr]

U.S. health care delivery is dumb as ****. I don't even know why people defend this zombie garbage except for that fact that you are paid better than anywhere else. BeSt MeDiCaL cArE iN tHe WoRlD

Because in many ways we are the best. No one country has the monopoly on best care.

 

[deleted480308]

U.S. health care delivery is dumb as ****. I don't even know why people defend this zombie garbage except for that fact that you are paid better than anywhere else. BeSt MeDiCaL cArE iN tHe WoRlD

We actually do have pretty good care

 

[Sine Cura]

I am really not going to go out of my way to defend a non-system that still allows the concept of a "coverage gap"

 

[KidPharmD]

Your state board didn’t waive rules for Covid? What kind of lame state board is that


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Our board didn't wave labeling requirements either. Luckily we already had a system in place to dispense the remainder of an albuterol MDI. However, they still have to be labeled appropriately with some record keeping.

I am really not going to go out of my way to defend a non-system that still allows the concept of a "coverage gap"

I think the problem is that we can have the best "care" in the world but the economics of the system means that too many people don't have access to that care.

 

[trailerpark]

WM just added a $24 dollar albuterol inhaler (generic Proventil specific NDC) to their "4$/$10" list.

 

[maria1oh]

Refer them to 340b pharmacy and prices are based off incomes.

 

[MrBonita]

My homies in San Diego always cross the border. Inhalers veinte dolares and they speak Ingles

 

[confettiflyer]

Our board didn't wave labeling requirements either. Luckily we already had a system in place to dispense the remainder of an albuterol MDI. However, they still have to be labeled appropriately with some record keeping.




I think the problem is that we can have the best "care" in the world but the economics of the system means that too many people don't have access to that care.

To clarify, our BOP didn’t waive labeling requirements, but (I think) they explicitly carved it out and expressly made it legal to dispense the remainder (and it doesn’t count against any limit that exists).

But yes, still needs name/drug name/etc on label. Luckily most EHR systems can do that easily (was easier for us to just make preprinted labels/kits for ED use/dispense)

 

[Dred Pirate]

what is the cheapest steroid inhaler our there? (and what is the average cash price/goodrx price?)
How much air duo usually run?
I get asked this in the ED every now and then - and our computer system doesn't show us the price of anything - so I am kind of removed from knowing actual cost much these days.
And PS - I remember when aluberol inhalers were like $8 (our cost) in the early 2000's when I was in school before the CFC vs HFA become an issue - then it jumped to ~$40 our cost