Yes, the price of an inhaler in the US is massively higher than overseas cost

Are Americans paying nearly $500 for an inhaler that would cost just $7 overseas?

U.S. Sen. Tammy Baldwin, D-Wis., says there is a vast difference in the cost of prescriptions in the United States and the rest of the world. 

"Big drug companies charge as little as $7 for an inhaler overseas and nearly $500 for the exact same one here in the US," Baldwin said Feb. 1 in a Facebook post. "That has got to end. We've got to hold Big Pharma accountable for their price-gouging tactics. I won't stop fighting until we do."

That massive cost difference piqued our interest.

When we asked for backup information, Baldwin’s campaign staff directed us to drug pricing websites, news articles and news releases on the cost of Combivent Respimat (ipratropium bromide and albuterol), a combination medication used to treat chronic obstructive pulmonary disease (COPD). 

Combivent Respimat is available only as a brand-name medication and not available in generic form, according to Medical News Today, which pointed out that the actual price a patient would pay for the medication depends on type of insurance plan, location and pricing at the patient’s pharmacy. Medicare does cover Combivent Respimat. 

According to Drugs.com, a pricing website, Combivent Respimat costs about $525 for a supply of 4 grams, depending on the pharmacy. 

It’s also important to note, that on a practical basis, because of insurance and Medicare coverage, few people in the United States would actually pay $500 out of pocket

"Quoted prices are for cash-paying customers and are not valid with insurance plans," the website says  says. 

Another online drug pricing guide, GoodRx, puts the price of Combivent Respimat between about $477 and $584 at Madison, Wisconsin, pharmacies:

• Walgreens —    $508.39 

• Walmart —----   $514.45

• CVS Pharmacy-$508.14

• Hy-Vee —--------$477.97

• Costco —---------$584.59

• Target —----------$508.14

• Metro Market —-$511.00

• Pick ’n Save—---$511.00

So, Baldwin is on target on the cost in the US.

According to a Jan. 8 news release from U.S. Sen. Bernie Sanders, I-Vt., Combivent Respimat sold for just $7 In France.

Sanders, chairman of the Senate Committee on Health, Education, Labor, and Pensions, sent letters to the CEOs of four pharmaceutical companies announcing an investigation into the high prices the companies are charging for inhalers. Baldwin and Democratic Sens. Ben Ray Luján of New Mexico and Ed Markey of Massachusetts also signed the letters.

The letters were sent to the four biggest manufacturers of inhalers sold in the United States — AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline (GSK) and Teva.

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"It is beyond absurd that Boehringer Ingelheim charges $489 for Combivent Respimat in the United States, but just $7 in France," Sanders said in the news release.

The news release said the Committee’s source for the price of Combivent Respimat in France was the Navlin international drug pricing database. 

Baldwin, in the news release, accuses companies of "jacking up prices and turning record profits."

Dr. William B. Feldman noted that Baldwin is referring to list prices here — which are the prices that uninsured patients in the U.S. pay and the prices to which out-of-pocket costs are often tied.

"Manufacturers give sizable (confidential) rebates to insurers, and so the net prices for inhalers in the U.S. are below list prices — but still much higher than the net prices abroad," Feldman said in an email to PolitiFact Wisconsin. 

Feldman, who works at Brigham and Women’s Hospital in Boston and Harvard Medical School, said a key reason inhaler prices remain so high in the U.S. is that there is very little generic competition. 

"Brand-name manufacturers have erected large patent thickets that keep generic competitors off the market," Feldman said. " Inhaler prices are low elsewhere, in part, because governments negotiate prices based on the value of the drugs compared to existing therapies."

David Kreling, professor emeritus in the School of Pharmacy at the University of Wisconsin-Madison, said the U.S. price quoted by Baldwin sounds about right.

"The $500 number may be in the ballpark for U.S. patented (brand-name, newer) drugs," Kreling said in an email to PolitiFact Wisconsin. "That would be consistent with my understanding of market data on sales by firms in the U.S. Things in the $7 range, here, only reside within the off-patent generic drug market (where we have low prices, sometimes at or near lowest in the world)." 

Baldwin said "big drug companies charge as little as $7 for an inhaler overseas and nearly $500 for the exact same one here in the US."

Our review, and that of experts, found the numbers checked out.

Experts cite a variety of reasons for the price differences, including very little generic competition in the United States, and few people in the United States would actually pay $500 out of pocket because of insurance and Medicare coverage. 

For a statement that is accurate but needs clarification or additional information, our rating is Mostly True.