Use and Out-of-Pocket Costs of Inhaler Devices by Payer Type and Estimated Carbon Dioxide Emissions

Introduction

Hydrofluoroalkane (HFA)–pressurized metered-dose inhaler (MDIs) have substantially higher global warming potential (GWP) than propellent-free dry powder inhalers (DPIs) and soft mist inhalers (SMIs).¹ Despite federal efforts to address the environmental impact of inhalers with high GWP, they persistently contribute 2.3 million metric tons (MMTs) of carbon dioxide equivalent (CO₂e) emissions. While a recent US Senate investigation highlighted concerns about the high cost of inhalers with low GWP, particularly DPIs, information on the affordability and use of inhalers based on their GWP potential by payer type is lacking. We analyzed all-payer data on prescription fills and out-of-pocket (OOP) costs and quantified CO₂e emissions for all inhalers by product type, therapeutic class, and specific products by payer type in the US.

The full study can be reviewed in JAMA Network Open.

Qato DM, Scannell C, Li Q, Linder E, Janson C, Wettermark B. Use and Out-of-Pocket Costs of Inhaler Devices by Payer Type and Estimated Carbon Dioxide Emissions. JAMA Netw Open. 2026;9(9):e2634313. doi:10.1001/jamanetworkopen.2026.34313