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Published: Friday, 15 February 2013 07:39

Written by 340B Editor

Many calls are coming in reporting that prescriptions for Combivent Inhalation Aerosol have increased from $25 to $210 when switched to Combivent^® Respimat^® Inhalation Spray, even with 340B pricing.

As you may be aware, Combivent Inhalation Aerosol inhaler is being phased out in favor of the new,Combivent^® Respimat^® Inhalation Spray (20 mcg ipratropium bromide (monohydrate) and100 mcg albuterol (equivalent to 120 mcg albuterol sulfate) per actuation)because the original inhaler contained ozone damaging chlorofluorocarbons (CFC) as a propellant. The manufacturer has been ordered to stop making or selling the inhalers by December 31, 2013, but the company is planning to phase it out much sooner for a smoother transition to the new CFC free Combivent Respimat Inhalation Spray. The phase out is projected to be complete in July 2013.¹ So, what options are available for your patients that cannot afford the more expensive Combivent Respimat Inhalation Spray?

One option would be to switch patients to two inhalers, one containing albuterol and one containing ipratropium. This would keep them on the same medications as before, but may have an added inconvenience of an additional inhaler to carry around. Another consideration is to move patients to the nebulizer solutions; this would take more time and is less convenient to administer, however it may be a logical choice for patients that already own a nebulizer machine. If your patient was doing well on the Combivent Inhalation Aerosol inhaler, then one of these options would probably make for an easy transition.²

Alternatives with the same active ingredients as Combivent Inhalation Aerosol

Another option would be to try your patients on different medication(s) indicated for COPD. Tiotropium is longer acting, commonly used for COPD management, and considered comparable to ipratropium as an anticholinergic agent. Other options to try would be levalbuterol, a long acting β2 agonist like salmeterol or formoterol, inhaled corticosteroids, or theophylline. Other alternatives should be considered depending on the severity of the patient’s COPD.²

Alternatives with different ingredients than Combivent Inhalation Aerosol

Combinations

Given the elevated cost of the new Combivent Respimat inhaler, this is a great opportunity to reassess your patients’ COPD status. A necessary change in therapy of this may provide a chance to keep in touch with your patients and their health needs or even warranted to help address associated problems that were not previously recognized. There are many options for treatment available, and therefore many ways to smoothly transition your patients off of their old Combivent inhaler.

Lauren Hedges

Pharm.D. Candidate 2015

OSU/OHSU College of Pharmacy

* See 340B Price Guide for pricing. Estimated 30 day supply. Includes dispensing fee.

a. Brand costs less than generic

1. U.S. Food and Drug Administration (April 4, 2013). Phase Out of Combivent Inhalation Aerosol. Retrieved from: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm345841.htm
2. U.S. Food and Drug Administration (May 20, 2013). Drug Treatments for Asthma and Chronic Obstructive Pulmonary Disease that Do Not Use Chlorofluorocarbons. Retrieved from: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm082370.htm