Yesterday’s NYT special report on asthma, The Soaring Cost of a Simple Breath, chronicles how the disease drives pharmaceutical costs. Asthma is the most common chronic disease in the U.S., affecting some 40 million adults and children. Medical research has developed a fairly effective 
regimen of inhalers, nasal sprays, and pills to manage it, yet the cost of asthma to the U.S. health system is a staggering $56 billion, according to the CDC (including hospital visits and more than 3,300 deaths annually). The good news is that the U.S. is catching on to the best treatment practices being aggressively pursued by countries with national health systems, encouraging patients to use inhalers to cut down on the incidence of emergency room use and hospitalizations.
But price can get in the way: for example, the steroid inhaler Pulmicort retails for about $175 in the U.S. (versus $20 in the U.K., where the national health service buys it at this price and dispenses it free to asthma patients) and Albuterol, one of the oldest asthma medicines, which cost about $15 per inhaler a decade ago, has since shot up to $50 to $100 each after it was repatented. California’s Medicaid program spent $61 million on asthma medicines last year, paying more than $200 for many inhalers.
The NYT report explores most closely the relationship of patent law to therapy costs, noting that US government policy works to disfavor generic drug development and doesn’t actively negotiate lower costs for patented brand names. “The high prices in the U.S. are because the F.D.A. has set the bar so high that there is no clear pathway for generics,” said Lisa Urquhart of EvaluatePharma, a consulting firm based in London that provides drug and biotech analysis. In addition, federal insurance programs like Medicare and the forthcoming ACA (“Obamacare”) prohibit government negotiation for bulk pricing on pharmaceuticals. In contrast, German regulators set drug wholesale and retail prices. In other European countries, national health policy precludes paying more than their neighbors for any given drug. Under Japanese law, the price of a drug must go down every two years.
There is no doubt that tackling the U.S. patent system and health care purchasing policies present one, direct way of bringing down the soaring cost of breathing for asthmatics. But what about looking upstream, to bring down the incidence of the disease itself? As this blog reported last spring, there is a well studied link between poor air quality in poor neighborhoods and higher incidence of heart and lung disease. The ATSDR (part of the CDC), the EPA and NIH, and California Department of Health: all provide information on the links between outdoor air quality and asthma. Even this NYT special report tacitly references the relationship of the environmental to asthma: “Oakland, a city subject to pollution from its freeways and a busy seaport, has four times the hospital admission rate for asthma as elsewhere in California.”