Coughing, wheezing, shortness of breath, chest tightness — these are common symptoms of asthma, which causes the lungs to become inflamed and narrowed and produce extra mucus, causing difficulty breathing.  

More than 28 million people in the United States have asthma, making it one of the most common — and the most expensive — conditions in the country.  

The most common treatment for asthma is medication administered via an inhaler. This type of treatment has become increasingly more expensive for a few reasons:  

• A ban on propellants once used for inhalers. In 2008, the U.S. Food and Drug Administration (FDA) banned inhalers with chlorofluorocarbons (CFCs) because of their environmental impact. Drug manufacturers turned to hydrofluoroalkane (HFA), which are more environmentally friendly though more expensive. The out-of-pocket cost for an inhaler rose from $13.60 in 2004 to $25 in 2008 to $98 in 2024. That figure keeps climbing.  
• The use of biologics to treat asthma. Biologic medications use living bacteria or proteins to block specific molecules, such as those that trigger inflammation in asthma. With complex production and high development costs, these types of medications can sometimes cost thousands of dollars per dose.  
• Price caps don’t apply to certain insurance programs. In 2024, three major drug manufacturers announced $35 per month caps on out-of-pocket costs for asthma medications for people with commercial insurance (through a member’s job or federal or state marketplace) or no insurance. However, this doesn’t apply to public insurance programs like Medicare, Medicaid, CHIP or TRICARE. From 2012-–2018, Medicaid spend on inhalers increased from $2.1 billion to $4.6 billion, according to a 2021 study. That’s an increase of 119%.  

How the medication is administered and how it’s billed can also affect the overall cost. For example, some biologic medications are administered by a provider and billed under the medical benefit, while others are self-administered and may be covered under the pharmacy benefit. Differences in site of care, administration fees and benefit design can all influence total cost and member out-of-pocket expense — making it important to evaluate options across benefits whenever clinically appropriate. 

The expensive cost of medications means many patients decide to forego their treatment, with about 1 in 6 patients skipping their medication because of cost. This is especially true for specialty asthma drug therapy. A study from Prime found that half of members were not adherent to their specialty asthma medication six months after initiating treatment.  

But untreated asthma can lead to serious, sometimes fatal consequences. It often results in children missing school and adults missing work, leading to an economic impact of more than $80 billion and medical costs that are more than $3,000 higher per year than those without asthma.  

How Prime keeps costs in check through MedDrive^® 

Primehelps provide members with a clear path to care through its data-driven, clinically grounded solutions. MedDrive® is one way payers can better optimize spend and utilization. 

“Our goal is to make sure members who need asthma treatment can access the right therapy at a cost they can afford,” said Christina Ku, PharmD, senior director of pharmacy trade relations. “By taking a holistic view across medical and pharmacy benefits, MedDrive helps identify opportunities to simplify therapy selection and promote lower-cost alternatives within the same class, helping reduce costs while maintaining positive member outcomes.” 

For select therapies, MedDrive evaluates utilization patterns and identifies opportunities to drive clinically appropriate, lower-cost choices. When it comes to injectable asthma biologics, for example, MedDrive can provide an analysis of lower-cost alternatives within the same therapeutic class and help shift utilization away from higher-cost medical drugs when appropriate.  

This includes cross-benefit drug management, where a lower-cost, self-administered medication may be preferred over a provider-administered product — helping reduce total cost while creating a more streamlined experience for members and providers. 

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Learn more about how Prime supports members with asthma