Cost of Asthma Care in People of Color

Access to healthcare is not equal in the United States, which is true for adults and children living with asthma. Black, Latinx, and Indigenous people bear the highest burden of asthma in the U.S. and higher rates of asthma death. Black communities are at especially high risk due to unequal access to health care, structural racism, and a historic distrust in the health care system.

The cost of asthma medications plays a central role in these disparities. Fortunately, there are resources to reduce these costs, including financial assistance programs and generic versions of approved asthma medications.

This article outlines the costs of asthma care in the United States today, including its effect on productivity and quality of life and why certain communities are disproportionately affected.

Costs Associated With Asthma Care

According to an analysis from the Centers for Disease Control and Prevention (CDC), the annual per-person cost of asthma care in the United States was $3,266 (in 2015 dollars).

The lion's share of these expenses were attributed to prescription drugs ($1,830), followed by office visits ($640), hospitalizations ($176), outpatient hospital visits ($176), and emergency room visits ($105).

Not surprisingly, the per-person annual cost of asthma care among uninsured people was 35% less ($2,145) than the national average—mainly due to affordability and unequal access to care.

With Insurance

Despite improved access to health care under the Affordable Care Act (ACA), studies suggest that having a lower income reduces a person's ability to maintain asthma control. This is true despite their insurance status.

In fact, a 2022 study found that low-income individuals with asthma who accessed care through the ACA did not experience significant changes in their asthma control. In total, 22% and 31% of the 4,043 people included in the study reported problems affording their medications and medical visits, respectively.

According to the CDC analysis, people with asthma are more likely to have health insurance than those without asthma, due in large part to the need for ongoing care and treatment. Even so, many insured people struggle with the cost of care, whether it's due to the price of medications or the cost of seeing a primary care provider or an asthma specialist.

Among adults with full health insurance coverage, one in eight report problems affording asthma care. Among those with partial or no coverage, nearly half struggle with affordability.

While having insurance generally improves health outcomes in people with asthma, not everyone benefits equally. A bigger factor appears to be a family's annual income.

Without Insurance

Having no insurance almost invariably leads to poorer outcomes in people with asthma. Numerous studies have shown a direct association between the lack of insurance and the increased frequency of emergency room visits among people with asthma. What may surprise you is that it seems to have the opposite effect in terms of hospitalizations.

A 2020 study reported that having no health insurance increases the odds of an emergency room visit by 30% for the treatment of an asthma attack.

On the other hand, having no insurance decreases the odds of hospitalization for asthma by 34%. Researchers found that uninsured and low-income people who sought emergency care often did so for low-acuity events, meaning milder attacks that generally don't require inpatient care.

What this suggests is that uninsured people without continuous care for their asthma may have no other option but to go to an emergency room when they have an attack.

Regarding health care in the United States, communities of color are disproportionately affected. Black and Latinx people are especially more likely to seek emergency care for asthma than White people.

Hospital Bills

The hospital bill for one severe asthma event can be staggering. According to a 2014 report from the Agency for Healthcare Research and Quality (AHRQ), the average cost of an asthma-related hospitalization from 2000 to 2010 was $3,600 for children and $6,600 for adults.

The AHRQ also reported that the rate of asthma-related admissions was more than three times higher among Black children and two times higher among Black adults than for their White counterparts.

For some patients, the costs may be far greater. A 2015 study that included all ages found an average length of stay for asthma-related hospital admissions was 3.9 days at a cost of $6,688. If mechanical ventilation (machines that take over the work of breathing) was needed, the stay was increased to 8.3 days and $21,556 (in 2015 dollars).

Breathing Tools

Inhaled asthma medications, including inhaled steroids and long- and short-acting bronchodilators, remain the mainstay of asthma treatment. For most people with asthma, the drugs account for the majority of out-of-pocket costs.

According to data from Medicare, the most money spent on asthma inhalers today is for combination inhalers that contain both a long-acting bronchodilator and a steroid.

The average wholesale price (AWP) for these combination inhalers is as follows:

• Advair Diskus (fluticasone/salmeterol): $390 to $640, depending on the drug strength
• Advair HFA (fluticasone/salmeterol): $358 to $622, depending on the drug strength
• Breo Elipta (fluticasone/vilanterol): $447
• Dulera (formoterol/mometasone): $374
• Symbicort (budesonide/formoterol): $352 to $390

The AWP does not reflect the cash price that people without insurance have to pay at checkout. Every state has different ways of calculating these prices and dispensing fees, both of which increase out-of-pocket costs.

Even for people with insurance, co-pay (a fixed amount the patient pays) or coinsurance (a percentage paid by the patient) costs can still be prohibitive.

These issues affect many communities of color that tend to have higher rates of poverty and unemployment. Studies have shown that uninsured and partially insured Black people are nearly twice as likely as White people to report drug affordability as a barrier to asthma care for their kids.

Other Hidden Costs

Over 25 million people in the United States are currently diagnosed with asthma. In 2017, more than 11 million people in the United States reported having at least one asthma attack in the prior 12 months. Of these events, there were 1.8 million emergency room visits, nearly 200,000 hospitalizations, and about 3,500 deaths.

With that said, the cost of asthma extends well beyond even these dire statistics, reducing productivity and the quality of life of those affected.

Missed Time at Work or School 

According to a 2019 study, the United States is expected to spend over $300 billion on direct costs associated with asthma through the year 2038. This doesn't take into account indirect costs like reduced job productivity, the cost of which is no less staggering.

According to the research, uncontrolled asthma will increase the direct cost of care by $1,349 per year while reducing work productivity by nearly 13%. For a 52-week work year, that translates to 6.6 weeks of lost school time or work time per year.

You don't have to look 20 years ahead to note the impact of asthma on a person's productivity. A 2020 study reported that the annual indirect cost of lost productivity was significantly higher among people with partly controlled asthma ($10,448) and poorly controlled asthma ($14,764) than those with well-controlled asthma ($6,353).

Effect on Quality of Life 

Achieving asthma control is associated with improvements in a person's quality of life, better work performance, and reduced medical costs. But the reality is that many at-risk populations are unable to achieve these goals, including Black people ages 18 to 29, who tend to have poorer outcomes and lower rates of treatment adherence.

The loss of quality of life can be especially impactful in people with uncontrolled asthma in different ways, including:

• The rigors of coping with acute asthma symptoms
• Limitations on physical activity due to reduced lung capacity and breathing problems
• Limitations on where you can go (such as avoiding the outdoors due to concerns about pollen, pollution, or other asthma triggers)
• The toll uncontrolled asthma can take on your emotional well-being

Discussing Affordability With Your Healthcare Provider 

The affordability of asthma treatment is one of the major barriers to controlling the disease over the long term.

Despite what some people may tell you, there are ways to significantly reduce your out-of-pocket costs whether you lack health insurance or have complete coverage. Start by speaking with your healthcare provider.

Ask About Generic Medications

While there are many asthma drugs whose patents grant them a period of exclusivity—and invariably higher prices—there are several whose patents have expired and are now available as generics.

These include lower-cost generics of the following brand name asthma drugs:

• Advair Diskus (fluticasone/salmeterol)
• Atrovent (ipratropium)
• ProAir HFA (albuterol)
• Proventil HFA (albuterol)
• Pulmicort (budesonide)
• Xopenex (levalbuterol)

Look Into Financial Assistance

Manufacturers of some of the pricier asthma medications offer financial assistance programs for qualified individuals. Among them:

• Patient-assistance programs (PAPs) are largely intended for low-income, uninsured people who may be eligible for low-cost or no-cost medications. Eligibility requirements vary but are typically based on an annual income of up to 500% of the federal poverty limit (FPL) as determined each year by the U.S. Department of Health and Human Services.
• Co-pay assistance programs (CAPs) provide eligible, insured individuals an allotted annual amount to cover copayment or coinsurance costs. The eligibility requirements are generally simpler than PAPs, allowing middle-income people access to significant cost savings.

There are also nonprofit organizations like the Patient Advocate Foundation (PAF) that grant annual awards to assist with asthma drug copayments.

 Where to Find Discounts

Prices can vary for asthma medications from one pharmacy to the next, sometimes significantly. It often pays to shop around for the best prices or to use an online price comparison tool like GoodRx or NeedyMeds.

GoodRx also helps you find coupons from a comprehensive list of participating pharmacies. Similar discount coupons are available from free programs like Optum Perks, SingleCare, and ScriptSave WellRx, and subscription programs like Blink Health.

Filing for Disability With Asthma

If your asthma is severe enough that you cannot work, you may be qualified for a monthly Social Security Disability Insurance (SSDI) benefit. These benefits are intended for people who are totally disabled and unable to work for a year or more because of their disability.

To qualify, you must have a medical condition that meets the Social Security Administration's (SSA) definition of a disability. The monthly benefit is calculated based on work credits accrued over the years (maximum four per year) from wages or self-employment income covered by Social Security.

Severe asthma is considered a qualifying medical condition. When you apply, you must show that you have been diagnosed with asthma and that your asthma is severe enough to prevent you from obtaining gainful employment.

You can apply for disability benefits by mail or online, or by visiting your local Social Security Administration office. You can also apply by phone by calling 1-800-772-1213 (available Monday through Friday from 7:00 a.m. to 7:00 p.m. Eastern Standard Time).

Racial Disparities

The burden of asthma falls disproportionately on Black, Latinx, and Indigenous people. These groups have the highest rates of asthma, asthma hospitalizations, and asthma-related deaths of all other racial or ethnic groups in the United States.

Compared to White people, Black and Latinx people are 150% and 200%, respectively, more likely to have asthma. This is due in large part to pollution inequity in the United States wherein Black and Latinx communities are 56% and 63%, respectively, more likely to be subject to excessive air pollution (considered a major risk factor for asthma).

There are also unique factors contributing to health disparities in the Black, Latinx, and Indigenous populations.

Black People With Asthma

Among Black people in the United States, research published by the AAFA suggests that 23% have no access to consistent health care compared to 17% of White people. Occupational discrimination, in which Black full-time employees make 22% less than their White counterparts, reduces disposable income that might otherwise be earmarked for asthma treatment.

As a result, Black women with asthma are today the group with the highest rate of asthma-related deaths of all racial or ethnic populations.

Latinx People With Asthma

Among Latinx people, 27% report having no access to consistent health care compared to 17% of White people. Lower rates of post-secondary education compared to White people (29% vs. 45%) impact health knowledge and literacy. Language barriers and lower rates of Latinx healthcare workers further impact the quality of care in hospitals and clinics.

As a result, Latinx people are three times more likely to die from asthma than White people and twice as likely to have a severe asthma attack.

Indigenous People With Asthma

Among Indigenous people in the United States, 24% of American Indians and Alaska Natives live below the poverty threshold. Compared to their White counterparts, Indigenous adults and youth are 30% and 50%, respectively, more likely to have obesity (another major contributing factor to asthma).

As a result of these and other issues, Indigenous people are twice as likely to have daily asthma attacks compared to White people and more likely to experience mental health problems as a result.

Summary

Asthma does not affect all groups equally. In the United States, people of color have higher rates of asthma and also are more likely to be hospitalized, need emergency care, and die because of the disease.

Unequal access to health care and insurance, as well as the high cost of inhaled asthma medications, contributes to this disparity. But there are other unique social, cultural, and economic factors that influence asthma in each of these at-risk groups, including structural racism, discrimination, and language barriers.

Despite the barriers, there are ways to access treatment through manufacturer assistance programs, copay assistance programs, discount coupons, and switching from brand-name drugs to less expensive generic options. If asthma is severe enough that you can no longer work, you may qualify to file for Social Security Disability Insurance (SSDI) benefits.

A Word From Verywell

Fearing the high cost of asthma care can deter some people from seeking treatment. Untreated asthma can lead to a variety of health complications, so it's important find accessible treatment options. Fortunately, there are several assistance programs available to make the cost of asthma treatment more affordable. Discuss these options with your healthcare provider to ease the financial burden while maintaining your health.