Drug Pricing Controversy: Asthma Inhaler Prices, Senate Investigation and $35 Caps (Case Analysis)

Chapter 4: Research a recent drug pricing controversy in the pharmaceutical industry

1. Summarize the case: who were the actors, how did the situation affect potential users and how was it addressed by the overseeing agency or Congress?
2. Identify any organizations or agencies that assisted in monitoring and exposing the pricing practice.
3. Identify the ethical dilemma surrounding the pricing practice.
4. Include a YouTube video link of a national news report about the situation.
5. From the perspective of a potential consumer, what would be a consumer’s initial reaction to the news report?

Original example for study purposes.

1. Summary of the Case

Asthma and chronic obstructive pulmonary disease (COPD) inhalers have been used for decades, yet many still cost hundreds of dollars in the United States. More than 27 million Americans have asthma, and President Biden noted that one company charged $9 for an inhaler in Germany but $286 in the United States (Watson, 2024). The main actors were the four largest U.S. inhaler manufacturers, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline (GSK) and Teva; pharmacy benefit managers and insurers that decide coverage; Congress; the Federal Trade Commission (FTC); and patients.

High prices affected users by forcing uninsured and underinsured patients to ration or skip controller medications, increasing the risk of asthma attacks and emergency visits. The human consequences became national news through the case of Cole Schmidtknecht, a 22-year-old Wisconsin man with lifelong asthma. In January 2024, his pharmacy told him his Advair Diskus inhaler was no longer covered and would cost $539.19, compared with no more than $66 previously. He left without it, suffered a severe asthma attack five days later and died on January 21, 2024. His parents later sued Walgreens and the pharmacy benefit manager OptumRx (ABC30, 2025).

The issue was addressed by Congress and federal agencies. On January 8, 2024, Senate Health, Education, Labor and Pensions (HELP) Committee Chair Bernie Sanders and other Democratic senators launched an investigation, sending letters to the CEOs of the four manufacturers about their prices, patient assistance programs and manufacturing costs (KFF Health News, 2024). The FTC had already challenged improper patent listings on inhalers that can delay generic competition. Within months, Boehringer Ingelheim, AstraZeneca and GSK announced $35 monthly out-of-pocket caps for many patients, and the White House celebrated the result in April 2024 (Watson, 2024).

2. Organizations That Monitored and Exposed the Practice

• Senate HELP Committee: investigated pricing and pressured manufacturers to lower costs.
• Federal Trade Commission: challenged questionable patent listings that block cheaper generics.
• Asthma and Allergy Foundation of America: provided data and advocacy on the burden of asthma.
• News media such as ABC News and CBS News reported price comparisons and patient stories, including the Schmidtknecht case.

3. The Ethical Dilemma

The central ethical dilemma is the conflict between a company’s right to set prices that maximize profit and recover research and development costs, and patients’ right to affordable access to life-sustaining medicines. Many inhalers are decades old, and critics argue that minor device changes and patent strategies extend monopolies without meaningful innovation. From a utilitarian perspective, high prices that cause rationing, hospitalizations and deaths produce more harm than benefit. From a justice perspective, charging Americans many times more than patients in other countries for the same product is unfair. The case also raises questions about the responsibilities of pharmacy benefit managers and insurers whose coverage decisions determine what patients pay.

4. National News Report

ABC News: “Man dies after inhaler cost jumps $500, according to family”: https://www.youtube.com/watch?v=neAOdw7IWJg

5. A Consumer’s Initial Reaction

A potential consumer, especially someone with asthma or a child who uses an inhaler, would likely react first with shock and anger that a young man could die because a decades-old medicine suddenly cost more than $500. The next reaction would be fear and anxiety: “Could this happen to me?” Many viewers would check their own insurance coverage and prescription costs and feel distrust toward drug companies, insurers and pharmacies. Some might feel relief that manufacturers now offer $35 caps, but also frustration that it took a Senate investigation and a tragedy to bring prices down. This reaction shows why transparent pricing and patient protections are essential to maintaining public trust in the pharmaceutical industry.

References

ABC30. (2025, February 4). Young Wisconsin man dies from asthma attack after price of inhaler skyrocketed nearly $500: Lawsuit. https://abc30.com/post/cole-schmidtknecht-dies-asthma-attack-price-advair-diskus-inhaler-skyrocketed-500-lawsuit/15862168/

ABC News. (2025). Man dies after inhaler cost jumps $500, according to family [Video]. YouTube. https://www.youtube.com/watch?v=neAOdw7IWJg

KFF Health News. (2024, January 9). Sanders, Democrats to investigate asthma inhaler prices. https://kffhealthnews.org/morning-breakout/sanders-democrats-to-investigate-asthma-inhaler-prices/

Watson, K. (2024, April 3). Biden touts inhaler price drops with Bernie Sanders: “Finally, finally we beat big Pharma.” CBS News. https://www.cbsnews.com/news/joe-biden-bernie-sanders-inhalers-white-house-drug-prices/