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    Tallying costs for a simple breath

    OAKLAND, Calif. — The kitchen counter in the home of the Hayes family is scattered with the inhalers, sprays, and bottles of pills that have allowed Hannah, 13, and her sister, Abby, 10, to excel at dance and gymnastics despite a horrific pollen season that has set off asthma attacks, leaving the girls struggling to breathe.

    Asthma — the most common chronic disease that affects Americans of all ages, about 40 million people — can usually be well controlled with drugs. But being able to afford prescription drugs in the United States often requires top-notch insurance or plenty of disposable income, and time to hunt for deals and bargains.

    The arsenal of medicines in the Hayeses’ kitchen helps explain why.


    Pulmicort, a steroid inhaler, generally retails for more than $175 in the United States, while pharmacists in Britain buy the identical product for about $20 and dispense it free of charge to asthma patients. Albuterol, one of the oldest asthma medicines, typically costs $50 to $100 per inhaler in the United States, but it was less than $15 a decade ago, before it was repatented.

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    “The one that really blew my mind was the nasal spray,” said Robin Levi, Hannah and Abby’s mother, referring to her $80 copayment for Rhinocort Aqua, a prescription drug that was selling for more than $250 a month in Oakland pharmacies last year but costs less than $7 in Europe.

    The Centers for Disease Control and Prevention puts the annual cost of asthma in the United States at more than $56 billion, including millions of potentially avoidable hospital visits and more than 3,300 deaths, many involving patients who skimped on medicines.

    “The thing is that asthma is so fixable,” said Dr. Elaine Davenport, who works in Oakland’s Breathmobile, a mobile asthma clinic whose patients often cannot afford high prescription costs. “All people need is medicine and education.”

    With its high prescription prices, the nation spends far more per capita on medicines than other developed countries. Drugs account for 10 percent of the country’s $2.7 trillion annual health bill, even though the average American takes fewer prescription drugs than those in France or Canada, said Gerard Anderson, who studies medical pricing at Bloomberg School of Public Health at Johns Hopkins University.


    While prescription drug spending fell slightly last year, it is expected to rise as the economy recovers and as Americans become insured under the Affordable Care Act, said Murray Aitken of IMS Health, a tracker of pharmaceutical trends.

    For most patients, asthma medicines are life-changing, which keeps demand and prices high.

    Dr. Dana Goldman, of Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, said because inhalers are cheap to produce and so effective at keeping patients out of hospitals, most national health systems made sure they were free or inexpensive. But in America no generic asthma inhalers are available.

    Generic inhalers are common in Europe, where health regulators have been more flexible about mixing drugs and devices, and where courts have been quicker to overturn drug patent protection.