The Cost of Spiriva: Show Me the Money

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Suffering from chronic obstructive lung disease (COPD) stinks, and so does paying a ton of money for your COPD inhalers. Spiriva (tiotropium) is probably your most expensive inhaler and you will wonder if it’s worth the cost. Insurance companies don’t like to pay for it and there is no generic option that is similar.

Spiriva is a long-acting anti-cholinergic inhaler used once a day for COPD. Spiriva has been shown to work better than Atrovent (ipratropium), which has been the much cheaper mainstay of COPD treatment. Spiriva adds more bronchodilation and is longer acting than ipratropium so it is used once a day for COPD. A new similar twice a day inhaler, Tudorza Pressair, was just approved and is also an expensive brand name inhaler.

So, if you show the money for Spiriva will it show you results? Yes, it should. Continuous therapy with Spiriva appears to be well-tolerated, and is associated with decreased shortness of breath, improved quality of life and fewer COPD exacerbations. Now you’re talking.

Spiriva has been shown to be superior to Serevent (salmeterol) and to Atrovent (ipratropium). Therapy with Spiriva results in a significant delay in the time until first exacerbation, and fewer exacerbations per year, than treatment with salmeterol (Serevent). Worth the money?

Dr O.

A 30-day supply of ipratropium (Atrovent) inhalation solution is included in many pharmacies’ discount generic plans for under $10 – $15 per month, sometimes as low as $5, and it is considered a Tier 1 generic by most insurance plans. In contrast, Spiriva can cost close to $300 for a 30 capsule inhaler, and if covered by insurance, will be considered a high-copay Tier 2 or 3 brand.

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