"You have got to stay aware of the price of things when you don't have any money," Mr. Hunt said during an exam Tuesday at St. Vincent dePaul Health Center.
Fortunately for him, the clinic is one of several in Georgia that received help from a nationwide program to get the pricier inhalers to those who really need them. But making a transition to those inhalers, which is mandated by the end of 2008, could cost the country $1.2 billion a year, according to a recent study.
The 2007 ASPIRE campaign is a partnership of national advocacy groups that wants to distribute about 500,000 free inhalers donated by the Schering-Plough pharmaceutical company.
"I actually have been getting tons of e-mails back from clinics saying, 'Thank you so much. We ran out of the inhalers; we weren't going to be able to afford to get new ones. We have tons of children who need them," said Nicole Lamoureux, the executive director of the National Association of Free Clinics.
The problem will be on into the future with the newer, pricier inhalers.
"That's why the crisis is upon us because most of the generics" won't be available, said Pat Lynch-Hayes, a nurse practitioner at St. Vincent in Augusta.
Many of the current inhalers use chlorofluorocarbons, or CFCs, that deplete the stratospheric ozone and were banned by the United States and many countries in 1978 except for "essential uses," according to the Food and Drug Administration.
Inhalers using an alternative propellant have been approved since 1996, and in 2005 the FDA declared that inhalers using the banned propellant couldn't be sold after 2008. However, the more environmentally friendly propellant feels different from the older one and is much more expensive, an average of $39.50 versus $13.50 for a generic version of the older type, according to a study published last month in the New England Journal of Medicine.
The biggest impact from the change "surely will be cost, regardless of whether you're poor or not," said lead author Leslie Hendeles, a professor of pharmacy and pediatrics at the University of Florida. "If you have a prescription benefit plan, it will be a higher co-pay because the (newer) products are listed as (brand name) products."
And because of patent protections, there won't be any generics until 2012 or later, Dr. Hendeles said. With 54 million prescriptions for albuterol annually, the change could cost the United States about $1.2 billion a year, Dr. Hendeles said.
Mr. Hunt was left wondering whether the environmental benefit was enough "to counterbalance the effect it's going to have on people. If they raise the price up that much, a lot of people aren't going to be able to afford it."
But Schering-Plough said it was also committing to an assistance program to get the inhalers to patients, spokeswoman Julie Lux said.
"I think it's important that it not be kind of a one-shot deal but that we give people an option for access to this product on a long-term basis," she said.
Reach Tom Corwin at (706) 823-3213 or firstname.lastname@example.org.