Commercial formularies restrict access to lower-emission asthma and COPD inhalers

A study published in JAMA Network Open found that commercial insurance formularies made lower-emission inhalers less accessible than metered-dose inhalers for people with asthma or chronic obstructive pulmonary disease. Researchers examined 31,219 commercial plans across the 50 states and Washington, D.C., in May 2026.

For short-acting β2-agonists, 66.4% of plans covered only a metered-dose inhaler, with no propellant-free option. Propellant-free versions were covered by 89.5% of plans for inhaled corticosteroids and 82.6% for inhaled corticosteroid and long-acting β2-agonist combinations. They were also less often covered on preferred tiers without prior authorization or step therapy. The researchers recommended that payers put at least one propellant-free option per class on preferred tiers while preserving access to metered-dose inhalers when clinically indicated. The analysis measured plan-level coverage, not individual enrollment or out-of-pocket costs.