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Editor's Note
July 2015

On Chlorofluorocarbon Bans and Inhaled Albuterol Prices

JAMA Intern Med. 2015;175(7):1179. doi:10.1001/jamainternmed.2015.1696

The competing concerns and interests of both individuals and society must be considered when establishing regulatory policy. In 2008, the US Food and Drug Administration (FDA) banned albuterol inhalers containing chlorofluorocarbons. This decision was questioned at the time because the chlorofluorocarbons emitted from inhalers have an insignificant effect on ozone and because of the anticipated costs of transitioning to hydrofluoroalkane inhalers for patients with respiratory disease.1 With the ban, generically manufactured chlorofluorocarbon inhalers were discontinued, leaving only branded hydrofluoroalkane inhalers available for use, even though the main pharmacological ingredient in both types of inhalers (albuterol) had been available in various generic formulations since the 1990s. Jena and colleagues examine the consequences of the ban on privately insured patients with asthma, finding that the mean out-of-pocket prescription costs for albuterol increased by 50%, with a small decline in inhaler use but reassuringly no increased risk for emergency department visits or hospital admission.2 Left unanswered is how uninsured individuals with asthma are faring.

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