WASHINGTON, Jan. 8 – Sen. Bernie Sanders (I-Vt.), Chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP), Sen. Tammy Baldwin (D-Wis.), Sen. Ben Ray Luján (D-N.M.), and Sen. Ed Markey (D-Mass.) today sent letters to the CEOs of four pharmaceutical companies launching a major investigation into the extremely high prices these companies charge for inhalers that 25 million Americans with asthma and 16 million Americans with chronic obstructive pulmonary disease (COPD) rely on to breathe. The letters were sent to the four biggest manufacturers of inhalers sold in the United States – AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline (GSK), and Teva – which outrageously charge between $200 and $600 each for inhaler products that are typically purchased monthly.

“There is no rational reason, other than greed, as to why GlaxoSmithKline charges $319 for Advair HFA in the United States, but just $26 for the same inhaler in the United Kingdom,” said Chairman Sanders. “It is unacceptable that Teva is charging Americans with asthma $286 for its QVAR RediHaler that costs just $9 in Germany. It is beyond absurd that Boehringer Ingelheim charges $489 for Combivent Respimat in the United States, but just $7 in France. As Chairman of the Senate HELP Committee, I am conducting an investigation into the efforts of these companies to pump up their profits by artificially inflating and manipulating the price of asthma inhalers that have been on the market for decades. The United States cannot continue to pay, by far, the highest prices in the world for prescription drugs.”

“The exorbitant price of inhalers for Americans is just another example of big pharmaceutical companies putting profits over people. While families struggle to afford this lifesaving device, these four companies are jacking up prices and turning record profits,” said Sen. Baldwin. “No American who needs an inhaler to live a healthy life, especially children, should be forced to ration or forgo their medication because of cost. It is time we hold big pharmaceutical companies accountable for price gouging Americans.”

“Access to inhalers can mean the difference between life and a suffocating death. Asthma alone impacts 27 million Americans, and 3,500 die every year. Lives would be saved with necessary, preventable treatment. It’s wrong that so many Americans suffering from asthma and COPD cannot afford their inhalers,” said Sen. Luján. “Alongside Chairman Sanders and my colleagues, I urge these four pharmaceutical companies to cease anti-competitive practices and put patients first so those suffering from asthma can get the care they desperately need.”

“Big Oil burns dirty fossil fuels that not only pollute the air we breathe, but also supercharge wildfires and allergy seasons due to climate change,” said Sen. Markey. “It is essential that people have access to the medications they need to breathe. Instead of Big Pharma taking seriously their responsibility to ensure that people get the medications they need, these companies put profits over people. It is unacceptable and immoral that low-income communities too often are forced to breathe the dirtiest air and experience the highest rates of asthma.”

There is no reason for these products to be so expensive. The devices have been available since the 1950s and most of the drugs they use have been on the market for more than 25 years. In other countries, the exact same products are sold for far less. One of AstraZeneca’s inhalers, Breztri Aerosphere, costs $645 in the U.S. but just $49 in the U.K. Boehringer Ingelheim’s Combivent Respimat costs $489 in the U.S. but just $7 in France. GSK’s Advair HFA costs $319 in the U.S. but just $26 in the U.K, and Teva’s QVAR RediHaler costs $286 in the U.S. but just $9 in Germany. Those prices are only possible in the U.S. because these companies have manipulated regulations to boost their bottom lines.

The prices charged in the U.S. drive massive revenues for these four companies. In the past five years, AstraZeneca, GSK, and Teva made more than $25 billion in revenue from inhalers alone (Boehringer Ingelheim does not provide public information on its U.S. inhaler revenues). That is part of a broader pattern: between 2000 and 2021, manufacturers of all inhaler products in the U.S. brought in more than $178 billion in revenue.

In the letters sent today, the senators wrote that the revenue figures from these companies “are a direct result of the outrageous prices the companies charge. These prices force patients, especially the uninsured and underinsured, to ration doses or abandon their prescriptions altogether. The results are predictable and devastating. Without consistent access to inhalers, people with asthma and COPD are more likely to get sick, to be hospitalized, and to die. Asthma alone kills 3,500 people every year, and nearly all of these deaths are preventable with regular treatment and affordable care. This cannot be allowed to continue.”

Poor Americans are the most likely to have asthma and COPD and the least likely to be able to afford the inhalers they need to breathe. Exposure to pollution and tobacco smoke are major causes of asthma and COPD. And as the senators wrote in the letters, “In addition to being exposed to unhealthy environments, people who live in poor and underserved communities have limited access to primary care providers and specialists who can diagnose their asthma and treat their symptoms. As a result, not only are they more likely to have asthma, they are also more likely to need costly emergency care.”

In their letters to AstraZeneca, Boehringer Ingelheim, GSK, and Teva, Chairman Sanders, Sen. Baldwin, Sen. Luján, and Sen. Markey request that the companies provide information and documents on the internal decisions that ensure their inhalers do not face competition and can continue to bring in massive revenues, including on the following:

• How executives decide to add new features to old inhalers or to move patients off of old products and onto new products, both of which are common tactics to keep lower-cost generic competitors off the market.
• Whether the companies have evidence that their new products have any real clinical benefits compared to the old products.
• The costs involved in manufacturing their inhalers and information about their patient assistance programs – which provide free or discounted inhalers to patients – including how much the companies deduct from their corporate taxes for operating those programs.
• Finally, the letters request information on how much the companies spend on research and development for asthma and COPD.

These letters build on the HELP Committee’s previous efforts to ensure pharmaceutical companies provide life-saving medicines at affordable prices. In February, Chairman Sanders released a Majority Staff Report exposing the executive compensation practices of major pharmaceutical companies during the COVID-19 pandemic. In March, the Committee held a hearing on Moderna’s decision to increase the price of the COVID-19 vaccine, which was developed through a partnership with the National Institutes of Health (NIH). In May, the Committee held a hearing on the need to make insulin affordable for all Americans. In June, Chairman Sanders released a Majority Staff Report showing how pharmaceutical companies charge an average of $111,000 for new prescription drugs that were created with the help of NIH and funded by taxpayer dollars. In October, Chairman Sanders sent a letter to the Inspector General of the Department of Health and Human Services requesting an investigation into a decision by the NIH to grant an exclusive patent license to an unknown company connected to a former NIH employee. And in November, Chairman Sanders and all Democratic members of the HELP Committee invited the CEOs of three pharmaceutical companies to testify on the outrageously high cost of prescription drugs.

Read the letter to AstraZeneca, here.
Read the letter to Boehringer Ingelheim, here.
Read the letter to GSK, here.
Read the letter to Teva, here.